Vignette-Based Study of Ovarian Cancer Screening..
(ChemotherapyAdvisor) – A cross-sectional survey of physicians who offer women’s primary care found 33% believe transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125) to be effective screening tests for ovarian cancer, even though current clinical guidelines recommend against such screening, according to a study published in the February 7 issue of Annals of Internal Medicine.
These results suggest some women are being exposed to the documented risks of these tests, which include high-false positive rates and low positive predictive values. In addition, “no studies have shown that screening, even in high-risk populations, affects the morbidity or mortality of ovarian cancer,” wrote Laura-Mae Baldwin, MD, MPH, of the University of Seattle, Seattle, WA, and colleagues.
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The investigators randomly sampled 3,200 physicians equally from the 2008 American Medical Association Physician Masterfile lists of family physicians, general internists, and obstetrician-gynecologists. Of the 61.7% who responded to the 12-page questionnaire, which comprised a women’s annual examination vignette and questions about offers or orders for TVU and CA-125 screening, 1,088 were included in the study.
Physician-reported nonadherence to screening recommendations, “defined as sometimes or almost always ordering screening TVU or CA-125 or both,” was 28% for women at low risk for ovarian cancer and 65.4% for women at medium risk. Respondents reported routinely ordering or offering cancer screening for 6% of low-risk and 24.0% of medium-risk women (P ≤0.001).
Adjusted analysis found the strongest predictors of physician-reported nonadherence to be “actual and physician-perceived patient risk, patient request for ovarian cancer screening, and physician belief that TVU or CA-125 was an effective screening test,” the investigators noted. Physicians more likely to offer screening were those with a personal history of cancer, in solo practice, and with a longer time in practice.
