Task force maintains recommendation against ovarian cancer screening
The U.S. Preventive Services Task Force today released a draft recommendation statement and evidence review on ovarian cancer screening that is consistent with its final recommendation in 2012.
The USPSTF’s “D” recommendation advises against screening for ovarian cancer in women who have no signs or symptoms, noting that screening does not decrease the number of deaths from ovarian cancer and may lead to women having unnecessary surgery.
The draft recommendation does not apply to women at high risk for ovarian cancer, such as women with known BRCA1 and BRCA2 mutations.
Maurie Markman, MD, president of medicine and science at Cancer Treatment Centers of America and a HemOnc Today Editorial Board Member, said he “completely” agrees with the draft recommendation.
“There is no value, and the potential for harm — anxiety, unnecessary invasive diagnostic testing — outweighs the benefit,” Markman told HemOnc Today. “Standard practice has been and continues to be that there is no role for ovarian cancer screening in women without a known genetic/familial risk.”
Ovarian cancer is the eighth most common cancer and fifth most common cause of cancer death among U.S. women. However, false-positive tests can lead to unnecessary surgeries to remove one or both ovaries and the fallopian tubes.
“The current screening tests do not do a good job of identifying whether a woman does or does not have ovarian cancer,” USPSTF chair David Grossman, MD, MPH, senior investigator at Kaiser Permanente Washington Health Research Institute, said in a statement. “The Task Force hopes that in the future, better screening tests for ovarian cancer will be developed.”
The draft recommendation statement and draft evidence review will be posted for public comment through Aug. 14, 2017.
“I agree with the task force, except in the case of a person with a known germline BRCA mutation prior to prophylactic surgery, typically at 40 years old,” Richard T. Penson, MD, MRCP, associate professor of medicine at Harvard Medical School, told HemOnc Today. “As you might suspect, this draft recommendation will not change what is being done in clinical practice.”
In its draft recommendation statement, the USPSTF noted the age-adjusted incidence of ovarian cancer from 2010 to 2014 was 11.4 cases per 100,000 women per year, and that most women with a positive screening test are found to not have ovarian cancer.
The USPSTF also reported that screening with transvaginal ultrasound (TVUS), testing for the serum tumor marker cancer antigen-125 (CA-125), or a combination of both, does not reduce the number of deaths from ovarian cancer.
Penson said he recommends biannual CA-125 and TVUS screenings if there is a family history of cancer at a very young age.
“There are those who claim that an algorithm focusing on the rate of rise of CA-125 in an individual woman over time versus an absolute level to be considered ‘abnormal’ may be more effective as an ovarian cancer screening strategy,” Markman said. “To date, the data supporting this hypothesis remains weak.”
In a separate recommendation statement, the USPSTF advises that women with a family history that indicates they are at risk for BRCA1 or BRCA2 mutations be referred for genetic counseling and, if indicated, genetic testing.
The most significant recent study on ovarian cancer screening is the U.K. Collaborative Trial of Ovarian Cancer Screening, a randomized controlled trial that compares annual multimodal screening vs. TVUS vs. control in 202,638 women aged 50 to 74 years from 13 centers in the United Kingdom. Researchers diagnosed ovarian cancer in 1,282 (0.6%) of the women — 338 (0.7%) in the multimodal screening group, 314 (0.6%) in the TVUS group, and 630 (0.6%) in the no screening group.
“The best interpretation in a prespecified analysis of death from ovarian cancer, which excluded prevalent cases, showed an overall average mortality reduction of 20% (P = .021),” Penson said. “However, there are three main reasons this hasn’t had any impact. First, mortality reduction was not significant in the primary analysis. Secondly, 2,641 women had to be screened annually for 14 years for each life saved. And, thirdly, the morbidity and mortality of laparotomy for a false-positive remains unacceptable.”– by Chuck Gormley
For more information:
Richard T. Penson, MD, MRCP, can be reached at email@example.com.
Maurie Markman, MD, can be reached at firstname.lastname@example.org.
For additional reading:
USPSTF. Draft evidence review for ovarian cancer: screening; Available at: www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review166/ovarian-cancer-screening1. Accessed on July 18, 2017.