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.
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.