More harm than good for Ovarian Ca screening

Article

Annual screening with transvaginal ultrasound (TVS) and CA-125 doesn’t reduce deaths from ovarian cancer, and the harms outweigh the benefits for asymptomatic women. So says the US Preventive Services Task Force (USPSTF) in reaffirming a 2004 recommendation, based on a new literature review.

Annual screening with transvaginal ultrasound (TVS) and CA-125 doesn’t reduce deaths from ovarian cancer, and the harms outweigh the benefits for asymptomatic women. So says the US Preventive Services Task Force (USPSTF) in reaffirming a 2004 recommendation, based on a new literature review.

Published online September 11 in the Annals of Internal Medicine, the recommendation follows a 2008 literature review by USPSTF and a bridging analysis of data through 2011 from randomized, controlled trials (RCTs) on ovarian cancer screening. A single RCT has published mortality results associated with TVS and CA-125, concluding that use of the diagnostics in combination did not reduce deaths due to ovarian cancer in asymptomatic women at average risk. Performing such screening, the USPSTF statement notes, could place this population at risk for major surgery when they do not have cancer.

The USPSTF guidelines do not apply to women with known mutations (such as BRCA1 and BRCA2) that are associated with increased risk of ovarian cancer. The panel also did not find sufficient evidence of benefit to warrant annual screening in women with a family history of ovarian cancer, although the available evidence suggests that the risk:benefit equation is less certain in these patients. 

Several trials analyzed by USPSTF have shown harms associated with ovarian cancer screening, including high false-positive and low positive predictive values for CA-125 combined with TVS, resulting in oophorectomy. The panel noted that evidence is limited on other types of screening, such as large-panel biomarker screening, and earlier detection based on a combination of symptoms and CA-125 or TVS. Results from the ongoing United Kingdom Collaborative Trials of Ovarian Cancer Screening, USPSTF hopes, will shed light on the value of an algorithm-based approach to diagnosis.

Read other articles in this issue of Special Delivery.

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raanan meyer, md
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