Ovarian cancer screening may not be needed on routine basis for all women says panel

By Dr. Ananya Mandal, MDApr 12 2012

In its latest review since 2004 of the benefits and harms of ovarian cancer screening, the United States Preventive Services Task Force found no new evidence to support routine screening.

The researchers looked at 64 studies, including controlled trials, systematic reviews and meta-analyses and found that a lack of accuracy in screening techniques leads to an inordinate number of false positives without a significant effect on mortality rates.

“Some new information on the harms of screening is available, and confirms what was suspected in 2004 about the hazards of screening — that many women could be subjected to unnecessary surgery,” the USPSTF wrote in an evidence review. “Several large screening studies currently underway should be able to provide direct evidence on the benefits of [transvaginal] screening ultrasonography or CA-125 [blood] testing in terms of mortality caused by ovarian cancer and other clinically relevant outcomes.”

A 2011 study of more than 78,000 women found diagnosis of and deaths from ovarian cancer did not differ between the group assigned to receive ovarian cancer screening (transvaginal ultrasound or (CA)-125), and a comparison group not assigned to screening. In that study, 10 percent of screened women had a false-positive test, and one third of those women had surgery to remove an ovary. A 2008 study of women in Japan found 33 surgeries were needed to diagnose one case of cancer detected by screening, the task force said. (Surgery is needed to confirm a diagnosis of ovarian cancer suggested by screening tests.)

The recommendations do not apply to women with risk factors for the condition, such as a family history of the disease or genetic mutations, such has versions of the BRCA1 and BRCA2 genes.

The tasks force recommendations are in line with those of the American Congress of Obstetricians and Gynecologists, which does not recommend screening for women without symptoms of the condition, and the American Cancer Society, which recommends screening for women only if they are at high risk for ovarian cancer or have persistent symptoms.

A draft of the recommendations has been posted on the task force website for public comment. The USPSTF will take public comments until May 8 before issuing final recommendations later in the year.