Sept 10, 2012: JAMA news - Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women « news@JAMA

Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women « news@JAMA

September 10, 2012

Task Force Reaffirms Advice Against Annual Ovarian Cancer Screening in Asymptomatic Women

Filed under: Gynecology,Ovarian Cancer,Women's Health — Mike Mitka @ 4:01 pm

The US Preventive Services Task Force says that annual screening for ovarian cancer with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen CA-125 is not recommended for asymptomatic women who do not have known risk factors for the disease.

The US Preventive Services Task Force (USPSTF) said that it cannot recommend annual screening for ovarian cancer in asymptomatic women because such testing does not reduce the number of deaths from the disease. The recommendation, which appears today in the Annals of Internal Medicine, does not apply to women with known ovarian cancer risk factors.

The recommendation is in line with the positions of major medical and public health organizations, which also discourage screening for ovarian cancer in the general population.

Ovarian cancer has the highest mortality rate of all gynecological malignancies and is the fifth leading cause of cancer death among women. It is also fairly rare in the general US population, with about 13 per 100 000 women developing the disease. Because the prevalence of ovarian cancer is low, routine screening is problematic because for the majority of women who have a positive test result, the result is a false positive. In such cases, screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have this malignancy.

The task force recommendation is a reaffirmation of its 2004 statement on ovarian cancer screening and incorporates interpretation of clinical trial results that have become available since then. The task force highlighted a 2011 study of 78 216 women assigned to annual screening (using transvaginal ultrasonography and testing for the serum tumor marker CA-125) or usual care. Ovarian cancer was diagnosed in 212 women (5.7 per
10 000 person-years) in the screening group and 176 (4.7 per 10 000 person-years) in the usual care group. But the increased number of ovarian cancer cases diagnosed in the group that was screened compared with the group receiving usual care was not significant, and there was no significant difference between the 2 groups with respect to the death rate. The study also found 3285 women with false-positive results, 1080 of whom underwent surgical follow-up, with 163 experiencing at least 1 serious complication.

Women with known risk factors for ovarian cancer, such as certain genetic mutations, Lynch syndrome, or a family history of ovarian cancer, should discuss the benefits and harms of screening with their physicians, the task force said. The use of oral contraceptives, pregnancy, breastfeeding, bilateral tubal ligation, and removal of the ovaries all reduce ovarian cancer risk.