Ovarian Cancer Screening 2018
The most current cancer statistics estimate the average age-adjusted incidence of ovarian cancer to be 11.4 cases per 100,000 women per year. Despite its low incidence, ovarian cancer is the leading cause of death from gynecologic cancer and the fifth most common cause of cancer death among US women.
Early stages of the disease are often asymptomatic. Symptoms are usually nonspecific and can include abdominal pain or pressure, bloating, constipation, urinary symptoms, back pain, or fatigue. Most women with ovarian cancer are diagnosed at later stages. Approximately 60% of women have metastatic disease at the time of diagnosis
The United States Preventive Services Task Force (USPSTF) reviewed clinical trials designed to evaluate ovarian cancer screening to update their previous 2012 recommendation. USPSTF identified 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.
USPSTF also reviewed evidence on harms of screening for ovarian cancer from these same 3 studies as well as a fourth study of fair quality reporting on quality of life and psychological harms of screening. The positive predictive value of screening tests for ovarian cancer was low. Most women with a positive screening test did not have ovarian cancer.The largest study had a false positive rate of 11.9% for transvaginal ultrasound and 9.0% for CA125. Surgery occurred in up to 3% of women with a positive screening test that ultimately did not have ovarian cancer. USPSTF found the evidence on psychological harms of screening to be inadequate and could not draw any definitive conclusion.
USPSTF concluded with moderate certainty that the harms of screening for ovarian cancer with CA125 testing, transvaginal ultrasound, or both outweighed the benefit. Therefore, USPSTF recommended against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome. This recommendation was consistent with their previous 2012 recommendation.
USPSTF’s recommendation against screening is consistent with the recommendations published by the American College of Obstetricians and Gynecologists, the American Cancer Society, the American College of Radiology, and the Academy of Family Physicians.
Reference
Final Recommendation Statement: Ovarian Cancer: Screening. U.S. Preventive Services Task Force. February 2018.
