USPSTF Discourages Screening Asymptomatic Women for Ovarian Cancer
The grade D recommendation is defined as having “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits,” the USPSTF noted, and suggest that practices “discourage the use of this service.” Women with known genetic mutations that increase risk for ovarian cancer are not included in this recommendation.
“Although ovarian cancer has the highest mortality rate of all gynecological malignancies, and is the fifth leading cause of cancer death among women…the disease occurs infrequently in the general US population, with an age-adjusted incidence of 13 cases per 100,000 women,” the USPSTF wrote. “As a result, the positive predictive value of screening for ovarian cancer—which directly depends upon the prevalence of the disease—is low, and the majority of women with a positive screening test will have a false-positive result.”
Specifically, 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”; moreover, “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.”
Women with BRCA1 and BRCA2 genetic mutations, Lynch syndrome, or a family history of ovarian cancer should be considered for genetic counseling and testing.
Reaffirmation of the 2004 recommendation is based on data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial of 78,216 U.S. women randomly assigned to annual screening (6 years for CA-125 testing and 4 years for transvaginal ultrasonography) or usual care and followed for up to 13 years. The study found no difference in either stage at diagnosis or death rate from ovarian cancer. Approximately 10% of those in the screening arm received a false-positive result, leading to oophorectomy in one-third, “with an overall ratio of surgeries to screen-detected ovarian cancer of about 20:1,” the USPSTF noted. For every 100 surgical procedures performed, nearly 21 major complications occurred.
Results from the ongoing U.K. Collaborative Trial of Ovarian Cancer Screening, which “is evaluating the effect of annual screening with serum CA-125 testing and transvaginal ultrasonography follow-up for abnormal results, as determined by an ovarian cancer risk algorithm taking into account age, absolute CA-125 level, and CA-125 trajectory over time, compared with annual screening with transvaginal ultrasonography or no screening” will help elucidate “relative benefits and harms of an algorithm-based approach to screening for ovarian cancer,” the USPSTF concluded.