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Tuesday, April 10, 2012

2012 April Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement



Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

 Screening for Ovarian Cancer

Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Release Date: April 2012

By Mary B. Barton, MD, MP, and Kenneth Lin, MD.

This report is based on research conducted by staff at the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.


Contents

Abstract
Introduction
Methods
Results
Conclusion
References

Abstract

Background: Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and was the fifth leading cause of cancer death among women in 2004.

Purpose: To perform a literature search for new, substantial evidence that would inform the reaffirmation of the U.S. Preventive Services Task Force's recommendation on screening for ovarian cancer.

Data Sources: We searched the MEDLINE and Cochrane databases. The searches were limited to English-language articles on studies of adult humans (age >18 years) that were published between July 1, 2002 and January 15, 2008 in core clinical journals.

Study Selection: For the literature on benefits of screening, we included controlled trials as well as systematic reviews and meta-analyses. For harms, we included controlled trials, cohort studies, case-control studies, and case series, as well as systematic reviews and meta-analyses. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion.
 (Results: Our literature search returned 64 potentially relevant titles that were entered into a reference database. A total of 60 articles were excluded after title and abstract review, and two more were excluded after full article review. We excluded 18 studies not related to ovarian cancer, 34 studies that did not describe screening, two studies that described no relevant outcomes, two studies that described a high-risk or special patient population, and three studies that were an inappropriate study type. One additional report of a prospective screening study that was included in the evidence for harms was identified after a supplemental search of MEDLINE for publications by selected authors)


Data Extraction: No new evidence was found on the benefits of screening for ovarian cancer. A single reviewer extracted data from studies on the harms of screening.

Data Synthesis: No new evidence was found on the benefits of screening for ovarian cancer. New evidence on the combination of ultrasonography and cancer antigen-125 blood tests for screening suggests that abnormal test results may result in surgery for a substantial proportion of women who do not have cancer.

Limitations: The search strategy employed may have missed some smaller studies on the benefits and harms of screening for ovarian cancer.

Conclusion: No new evidence was found on the benefits of screening for ovarian cancer. Screening asymptomatic women can result in unnecessary interventions, including surgery.

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