Ovarian cancer screening: a USPSTF recommendation statement

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The USPSTF states that the harms of screening for ovarian cancer in asymptomatic women outweigh the benefits.
The USPSTF states that the harms of screening for ovarian cancer in asymptomatic women outweigh the benefits.

Screening for ovarian cancer in asymptomatic women is not recommended, as the harms outweigh the benefits, according to the US Preventive Services Task Force (USPSTF).

These harms include many false-positive results, which can lead to surgical interventions in women who do not have cancer. Depending on the type of screening test used, the magnitude of harm ranges from moderate to substantial, and reflects the risk of unnecessary surgery.

The USPSTF's recommendation, which was given a Grade D, applies only to asymptomatic women. The clinical symptoms of ovarian cancer are nonspecific and often present at later stages of disease. Therefore, the use of clinical symptoms for risk stratification for the early detection of disease is difficult, according to the task force.

The USPSTF commissioned an evidence review of screening for ovarian cancer to update its 2012 recommendation and found 3 good-quality studies evaluating the effect of annual screening in asymptomatic women not known to be at high risk for ovarian cancer. None of the studies found that screening significantly reduced ovarian cancer mortality.

The largest and most recent trial, UKCTOCS, was a randomized, controlled trial of 202,638 postmenopausal women aged 50 to 74 years. More than 95% of trial participants were white; 1.6% reported a maternal history of ovarian cancer, and 6.4% reported a maternal history of breast cancer. The trial evaluated the effects of 2 screening strategies, transvaginal ultrasound or CA-125 testing with the Risk of Ovarian Cancer Algorithm (ROCA). Women randomized to the transvaginal ultrasound arm had annual screening with transvaginal ultrasound, while women randomized to the CA-125 ROCA arm had annual CA-125 testing with ROCA.

After a median follow-up of 11.1 years, ovarian cancer mortality was similar in the control and intervention groups (0.35%, 0.32%, and 0.32% in the control, transvaginal ultrasound, and CA-125 ROCA groups, respectively). The primary trial results found no significant difference in mortality (transvaginal ultrasound hazard ratio [HR], 0.91; CA-25 ROCA HR, 0.89).

Because most cases of ovarian cancer are diagnosed at later stages, when associated mortality is high, further research is needed to identify new screening strategies that could accurately detect ovarian cancer earlier, at a point when outcomes could be improved, noted the USPSTF.

In a separate recommendation, the USPSTF stated that women with a family history indicating that they are at risk for a deleterious gene mutation (BRCA1 or BRCA2) be referred for genetic counseling and, if indicated, genetic testing. The USPSTF also concluded in a separate recommendation statement that the current evidence was insufficient to assess the balance of benefits and harms of performing screening pelvic examination in asymptomatic, nonpregnant adult women.

Reference

  1. Draft Recommendation Statement: Ovarian Cancer: Screening. U.S. Preventive Services Task Force. July 2017.
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