How not to detect ovarian cancer

Screening with annual transvaginal ultrasound (TVU) and CA125 is ineffective at detecting early-stage ovarian cancer in both high- and low-risk women, according to the findings of a retrospective audit study involving 341 asymptomatic women.

In breaking down the participants, 179 of the women had more than a 10% lifetime risk of developing ovarian cancer, 77 fell into a moderate risk group (4%-0% lifetime risk), and 71 had less than a 4% lifetime risk.

Thirty women underwent exploratory surgery because of abnormal findings, but only two had cancer, and only one had ovarian cancer; the other had endometrial cancer.

The researchers calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for TVU in the whole cohort to be 33.3%, 85.8%, 0.6%, and 99.8%, respectively. For those at high risk, the same figures for TVU were 33.3%, 84.5%, 1.1%, and 99.6%, respectively. The values for both modalities for the entire study population were 66.7%, 82.9%, 1.5%, and 99.8%, respectively. The values for both modalities applied to the high-risk group alone were 50%, 82.8%, 1.3%, and 99.7%, respectively.

Woodward ER, Sleightholme HV, Considine AM, et al. Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high-risk and population risk women is ineffective. BJOG. 2007;114:1500-1509.