Screening for cancer of the ovary

Screening for ovarian cancer in asymptomatic women does not save lives, but rather causes more harm than good according to the latest recommendations from the United States Preventive Services Task Force(USPSTF).  Although the mortality rate from ovarian cancer is high, screening with either blood tests or radiologic imaging in women without known genetic risks or suggestive symptoms does not identify cancers at an early, curable stage. These conclusions, published in the September 11, 2012 issue of the Annals of Internal Medicine, reconfirm earlier reports from 2004 and 2008.

The new review included the results of a recent large screening study which compared the used of blood CA-125 tests and transvaginal ultrasound to no screening in a group of 78,216 women ages 55-74.  The subjects were randomized to either screening or no screening, and followed for up to 13 years. No significant difference in ovarian cancer diagnosis or death was observed. However, approximately 10 percent of the women in the screening cohort had a positive result from either blood testing or ultrasonography, and one third of these women had surgery to remove an ovary (with 15 percent of these having at least one surgical complication).

The USPSTF has been criticized in the past, particularly in its recommendations on mammography. This report, however, is consistent with the recommendations of other leading medical groups, including the American Cancer Society and the American Congress of Obstetrics and Gynecology.  The former’s position is that there is no screening test proven to be effective and sufficiently accurate in the early diagnosis or ovarian cancer.  However, they also emphasize that for high risk women (either with genetic testing showing a risk or a family history of the disease), the combination of a pelvic examination, transvaginal ultrasound and CA-125 testing may be considered.

Ovarian cancer causes over 15,000 deaths in the United States each year, and once diagnosed carries a high death rate, leading to the hope for an effective screening strategy.  Typical symptoms, such as pelvic fullness and pain, are both non-specific and usually not manifest until disease is spread. Unfortunately ultrasonography in asymptomatic women may reveal benign growths or cysts, which are both common, but not be able to differentiate them from early cancers. The CA-125 blood test may be elevated in the absence of a malignancy.

Some physicians and patients are likely to cling to the belief, or hope, that screening is useful. A report this past February indicated that about 33 percent of physicians routinely say they recommend this test.

If you have concerns, you should discuss the issue of ovarian cancer with your primary care physician. Plus, you should keep in mind, that unlike ovarian cancer, both breast and cervical cancer can be identified and cured through an appropriate screening protocol.