A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women

Epithelial ovarian cancer (EOC) is usually lethal unless it is diagnosed at an early stage,
thus early detection is likely to play an important role in reducing its mortality. Within
the Ovarian Specialized Programs of Research Excellence Pacific Ovarian Cancer Research
Consortium (POCRC) researchers have been working for a decade to discover, develop, and
validate biomarkers (proteins or substances found in blood) that could help save lives by
detecting EOC early. During the last five years several biomarkers, including CA125, have
been evaluated for their ability to detect EOC at an earlier stage. The best markers will now
be studied in a new randomized controlled trial of ovarian cancer screening.

Inclusion Criteria:

Risk Group 1, Women ages 25 - 80:

- The subject has tested positive for a deleterious germ line mutation in BRCA1 or
BRCA2.

Risk Group 2, Women ages 35 - 80, Pedigree conditions can be satisfied by multiple primary
cancers in the same person:

- The subject has a personal history of breast cancer diagnosed before or at age 50.

- OR the subject has a personal history of bilateral breast cancer

- OR the subject has one first-degree relative with breast cancer diagnosed before or at
age 50.

- OR the subject has two breast cancers in the first or second degree relatives, same
lineage, with at least one breast cancer diagnosed before or at age 50.

- OR the subject has three or more first or second degree relatives, same lineage, with
breast cancer diagnosed at any age.

- OR The family contains at least one ovarian cancer diagnosed at any age in the first
or second degree relatives.

- OR the subject is of Ashkenazi ancestry and has had breast cancer diagnosed at any
age.

- OR The subject is of Ashkenazi Jewish ethnicity and has one first or second degree
relative with breast cancer diagnosed at any age (must be in the same lineage as the
Ashkenazi ancestry)

- OR The subject has a male relative with breast cancer diagnosed at any age

- OR The subject has a personal history of a positive genetic test result for a
deleterious germline mutation in the P53 gene.

- OR The subject has tested positive for a deleterious germline mutation in one of the
DNA mismatch repair (MMR) genes associated with the Hereditary Non-Polyposis
Colorectal Cancer Syndrome (HNPCC, also known as Lynch Syndrome) The MMR genes include
MLH1, MSH2, MSH6 and PMS2.

- OR the subject has a first or second degree relative with an identified deleterious
germline BRCA1 or BRCA2 mutation, but has not yet undergone testing herself.

- OR the subject has a first or second degree relative with an identified deleterious
germline MMR gene mutation, but has not yet undergone testing herself.

- OR Probability of carrying a BRCA1 or BRCA2 mutation given family pedigree of breast
and ovarian cancers exceeds 20% by any existing BRCA mutational probability model.

Risk Group 3, Women ages 45 - 80:

- Have measurement of CA125, HE4, MMP7 or Mesothelin exceeding the 95th percentile;

- OR have a relative risk of at least 2 based on the EpiRisk logistic regression model
including age, family history, and other risk factors.

Exclusion Criteria:

- Removal of both ovaries for any reason.

- History of ovarian, fallopian tube cancer or peritoneal carcinomatosis.

- Currently pregnant.

- Unable or unwilling to provide informed consent.

- Unwilling to provide the name of a physician.

- Unwilling to sign informed consent and/or medical records release form.

- Current untreated malignancy (other than non-melanoma skin cancer).

- Currently receiving adjuvant chemotherapy or radiation therapy for cancer (except
tamoxifen or aromatase inhibitors +/- lupron). Patients who are being treated may
enroll 3 months after completion of last treatment.

- Intraperitoneal surgery within the last 3 months (laparoscopy or laparotomy).

- A medical condition that would place subject at risk as a result of the blood
donation, including but not limited to bleeding disorders, chronic infectious disease,
emphysema or serious anemia.

- Subject has a family member who is a carrier of a BRCA or MMR gene mutation and the
subject has undergone genetic testing that included the family mutation and no
mutation was found, and there are no cases of ovarian cancer in the family.