[Ann Intern Med.] Asymptomatic, low risk women should not be screened for ovarian cancer – new USPSTF statement

Image: CC/James Heilman. Ovarian cancer on CT scan. 

Primer: Ovarian cancer, while uncommon, is the most lethal gynecologic malignancy. In 2004, the U.S. Preventive Services Task Force (USPSTF) decided that the harms of ovarian cancer screening outweighed its benefits and classified the testing as grade D, recommending that physicians refrain from screening all asymptomatic women without known genetic susceptibility for ovarian cancer. As medicine continues to advance, the USPSTF decided to review newer literature with the goal of determining whether or not to change the previously established grade D recommendation.

This study: Through a 2008 review of observations of the harms of screening, combined with a 2011 review of randomized, controlled trials, the USPSTF drew the following conclusions from the studies. We highlighted key points below:

The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (2009 and 2011) – A randomized, controlled trial including 78,216 women assigned to either CA-125 serum tumor marker or transvaginal ultrasonography annual screening groups or a control group undergoing care without screening were followed for 13 years. The use of either screening methods did not reduce ovarian cancer mortalities when compared to those undergoing usual care (118 vs. 100 deaths, relative risk 1.18 [CI: 0.82-1.71]).

The PLCO, the Schizuoka Cohort Study of Ovarian Cancer Screening (2008) and the ongoing United Kingdom Collaborative Trial of Ovarian Cancer Screening(2005 and 2009) (both randomized trials) found that the large amount of false positives secondary to ovarian cancer screening methods’ low positive predictive values. This often leads patients to undergo unnecessary invasive procedures and surgeries for treatment and diagnostic confirmation.

There is not much evidence regarding the value of annual screening for high risk individuals, defined as those with BRCA1 and BRCA2 mutations, hereditary nonpolyposis colorectal cancer, or a family history of ovarian cancer. The USPSTF is looking to a continuing prospective cohort study, the United Kingdom Familial Ovarian Cancer Screening Study, to elucidate the benefit of screening high-risk patients.

In sum: The USPSTF reaffirmed its grade D recommendation against annual screening of asymptomatic, low-risk women for ovarian cancer stating that the harms of testing outweigh the potential benefits. The organization encourages high-risk women to seek additional genetic counseling prior to ovarian cancer screening and recognizes that its regulations are similar to those of other major health organizations.

Click to read the study in the Annals of Internal Medicine

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