Routine Ovarian Cancer Screening Nixed

The US Preventive Services Task Force (USPSTF) recommended that tests used to screen for ovarian cancer should not be routinely used in otherwise healthy women. These tests in­clude ultrasound imaging and assessing blood levels of CA-125. The recommendation was based on evidence that the risks of these tests outweigh the benefits. The panel agreed that the tests do not lower the death rate from ovarian cancer, and the false-positive yield leads to unnecessary procedures with high rates of complications. The full recommendation appears in the September 11 issue of An­nals of In­ter­nal Medicine.

Ovarian cancer accounts for about 3% of all cancers in women. It is difficult to detect at early stages, so most women who present with the disease are at relatively advanced stages, when it is often fatal.

The task force is an independent body of medical experts, and the current recommendation comes on the heels of rejection of routine PSA screening for prostate cancer in otherwise healthy men and against routine use of mammo­graphy in women under age 50 years. The de­cision was not based on the cost of screening, but rather on risks and benefits.

Some experts involved in the ovarian cancer screening recommendation ac­knowledge that many doctors will continue to perform screening despite the data, because patients may demand it. A recent study published in February in Annals of Internal Medicine found that one-third of 1088 physicians surveyed believed that screening was effective, and many routinely offered it to patients (Baldwin LM, et al. Ann Intern Med. 2012;156:182-194).

The chair of the USPSTF stated that no existing screening method reduces death from ovarian cancer. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery,” said Virginia A. Moyer, MD.

“Otherwise healthy women” refers to women who have no signs or symptoms of ovarian cancer and do not harbor the BRCA1 and BRCA2 mutations, which in­crease the risk of de­­veloping the disease.

Evidence for the recommendation in­cludes 3 major randomized clinical trials: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the UK Collaborative Trial of Ovarian Cancer Screening, and the Shizuoka Cohort Study of Ovarian Cancer Screening.

The PLCO trial, the results of which were published in the Journal of the American Medical Association in 2011 (Buys SS, et al. JAMA.

2011;305:2295-2303), included 78,216 women aged 55 to 74 years; half the women underwent screening and half did not. After 13 years of follow-up, the death rate from ovarian cancer was similar in both groups. However, in the screened group, 3285 women (10%) had false-positive results.

Surgery to remove the ovaries was performed in 1080 women, with a 15% rate of serious complications. The investigators found that the number needed to treat with surgery to find 1 case of ovarian cancer was 20 women.