US panel rejects ovarian cancer screening for asymptomatic women
The US Preventive Services Task Force has updated its 2004 recommendations on ovarian cancer screening to exclude asymptomatic women without known genetic mutations that increase risk for ovarian cancer.
The task force reviewed evidence-based literature on both the benefits and harms of the service and an assessment of the balance, the complications entailed in surgeries triggered by false-positive screening results and the history of detected ovarian cancer to establish its recommendations.
The most commonly suggested screening modalities for ovarian cancer involve transvaginal ultrasonography and serum tumor marker CA-125 testing. Although the bimanual pelvic examination is often conducted, in part to screen for ovarian cancer, its effectiveness and harms are not well known and were not a focus of the task force review.
A positive test is typically followed by surgical intervention and intraperitoneal or systemic chemotherapy.
“The USPSTF found adequate evidence that annual screening with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen (CA)-125 in women does not reduce the number of deaths from ovarian cancer,” Virginia A. Moyer, MD, MPH, the head of academic general pediatrics and professor of pediatrics at Baylor College of Medicine in Houston, and colleagues wrote in a statement published online in Annals of Internal Medicine.
In recommending against routine screening of asymptomatic women, the task force cited results of the NIH-sponsored Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which demonstrated that screening with CA-125 and transvaginal ultrasound did not reduce screened women’s risk for death from ovarian cancer vs. unscreened women.
The PLCO results showed that screening with CA-125 and transvaginal ultrasound had a positive predictive value for ovarian cancer of only 1%. In addition, 10% of women in the screened arm had false-positive results, which led to oophorectomy in one-third of cases. Overall, screened women had a 20:1 ratio of surgeries to screen-detected cancers.
In surgeries instigated by false-positive screening results, the rate of major complications was 21 per 100 surgical procedures.
The task force said the recommendation applies only to asymptomatic woman. The recommendations do not apply to those with known risk factors for ovarian cancer, including BRCA1 and BRCA2 genetic mutations, Lynch syndrome (hereditary nonpolyposis colon cancer) or a family history of ovarian cancer.
“There is adequate evidence that screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have cancer,” Moyer and colleagues wrote. “The USPSTF concludes that there is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits.”