Task Force reaffirms recommendation against routine screening for ovarian cancer

Annual ovarian cancer screening with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen (CA)-125 does not reduce the number of deaths from the disease in asymptomatic women, a review found.

The U.S. Preventive Services Task Force affirmed its 2004 and 2008 recommendations. The most recent affirmation, published in the Sept. 11 Annals of Internal Medicine, is based on a bridge literature search of randomized, controlled trials that was conducted in 2011. This is a grade D recommendation (moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits). The recommendation was published online Sept. 11 by Annals of Internal Medicine.

Women with known risk factors for ovarian cancer (e.g., genetic mutations such as BRCA, Lynch syndrome, family history) should discuss the benefits and harms of screening with their doctors. Use of oral contraceptives, pregnancy and breastfeeding, bilateral tubal ligation, and removal of the ovaries all reduce the risk for ovarian cancer.

Among the new evidence considered, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial of 78,216 American women found a nonstatistically significant increase in ovarian cancer diagnoses and no difference in either stage at diagnosis or death rate from ovarian cancer associated with screening, the Task Force said.

PLCO found that about 10% of participants in the screening arm received a false-positive result and that the positive predictive value of CA-125 testing and transvaginal ultrasonography screening was just over 1% across all screening rounds. One-third of women with a false-positive result had an oophorectomy, with an overall ratio of surgeries to screen-detected ovarian cancer of about 20 to 1. There were nearly 21 major complications per 100 surgical procedures performed on the basis of false-positive screening results.

A randomized trial set within the Shizuoka Cohort Study of Ovarian Cancer Screening evaluated the use of transvaginal or transabdominal ultrasonography in conjunction with serum CA-125 testing (positive threshold of >35 U/mL) and reported that an estimated 33 surgeries were required to diagnose one case of screen-detected ovarian cancer.

The U.K. Collaborative Trial of Ovarian Cancer Screening pilot trial and the baseline (prevalence) screening round of the full trial found that about 9% of women receiving baseline multimodal screening required repeat testing for abnormal results, and less than 1% of women had surgery. Among women having surgery for a false-positive result (47 of 97 women [48%]), about 4% experienced a major complication.