Image: New guidelines suggest screening for ovarian cancer in asymptomatic women holds more harm than benefit (Photo courtesy of Getty Images).
New guidelines released by the U.S. Preventive Services Task Force (USPSTF; Rockville, MD, USA) recommend against screening for ovarian cancer in women without symptoms.
The recommendation statement followed a review of evidence on the benefits and harms of screening in asymptomatic women not known to be at high risk for ovarian cancer. Given the lack of mortality benefit of screening, and the moderate to substantial harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concluded with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative.
The USPSTF further discourages all methods for routine screening, including transvaginal ultrasound, serum CA-125 testing, and pelvic examination with bimanual palpation of the ovaries, based on the results of three large good-quality studies. Adequate evidence from the same studies shows that the harms from screening for ovarian cancer, such as false-positive results, may lead to unnecessary diagnostic surgery to determine whether ovarian cancer is present, often resulting in removal of one or both of the ovaries and fallopian tubes, and that serious surgical complications can also result.
The recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome. Women with certain hereditary cancer syndromes, such as BRCA1 or BRCA2 genetic mutations associated with hereditary breast and ovarian cancer syndrome, as well as women with a family history of ovarian or breast cancer should consult with a health care professional. The USPSTF added that management of a diagnosed hereditary cancer syndrome and prevention of ovarian cancer in such women is beyond the scope of the recommendation statement.
“Ovarian cancer is a devastating disease, and we do not have a good way to identify women with ovarian cancer early enough to treat it effectively,” said USPSTF member Chien-Wen Tseng, MD, MPH, of the University of Hawaii (Honolulu, USA). “The task force is calling for research to find better screening tests and treatments that can help reduce the number of women who die from ovarian cancer.”
Ovarian cancer is the fifth most common cause of cancer death among U.S. women, with approximately 14,000 deaths per year. Symptoms are usually nonspecific and can include abdominal pain or pressure, bloating, constipation, urinary symptoms, back pain, or fatigue. Most women with ovarian cancer are diagnosed at later stages, and approximately 60% have metastases at the time of diagnosis. Mortality rates vary by stage at diagnosis; 5-year survival rates range from 92.5% for localized cancer to 28.9% for cancer with distant spread.
U.S. Preventive Services Task Force
University of Hawaii