You're right. We don't have screening like we do for cervical cancer. We don't even have a heralding symptom like endometrial cancer, where you might spot or bleed. Usually when you have symptoms with ovarian cancer, it's already at an advanced stage.
There are very good international studies done in the U.S., the U.K. and Japan, none of which showed screening had a large enough impact on identifying people. That's really why we shifted our energies into prevention.
We talked a lot about BRCA. That's 20% of high-grade, serious ovarian cancers. That leaves 80% of patients who don't have a family history who are out in the community. They are what we call general risk. That's where we think we need to actually put our energies and motivation. When those individuals are having a surgery in their abdomen, we've moved from focusing initially on gynecologic surgeries: If you're getting a hysterectomy but they're going to leave the tubes, why don't you remove the tubes so that the cancer never develops?
We're also now moving into the general surgery forum. If you're getting gallbladder surgery or a colorectal procedure, your tubes are there and they are accessible. You have a skilled surgeon in the room. Can we remove those tubes so that the individual, 15 years later, doesn't develop ovarian cancer?
Otherwise, we're very challenged. We don't have a magic screening tool in our pocket.