abstract
OBJECTIVE:
To
determine whether annual screening reduces ovarian cancer mortality in
women with a family history of breast or ovarian cancer.
METHODS:
Data
was obtained from the Prostate, Lung, Colorectal, and Ovarian cancer
trial, a randomized multi-center trial conducted to determine if
screening could reduce mortality in these cancers. The trial enrolled
78,216 women, randomized into either a screening arm with annual serum
cancer antigen 125 and pelvic ultrasounds, or usual care arm. This study
identified a subgroup that reported a first degree relative with breast
or ovarian cancer. Analysis was performed to compare overall mortality
and disease specific mortality in the screening versus usual care arm.
In patients diagnosed with ovarian cancer, stage distribution, and
survival were analyzed as a secondary endpoint.
RESULTS:
There
was no significant difference in overall mortality or disease specific
mortality between the two arms. Ovarian cancer was diagnosed in 48
patients in the screening arm and 44 patients in the usual care arm.
Screened patients were more likely to be diagnosed at an earlier stage
than usual care patients. Patients in the screening arm diagnosed with
ovarian cancer experienced a significantly improved survival compared to
patients in the usual care arm; relative risk 0.66 (95% CI, 0.47 to
0.93).
CONCLUSION:
Screening
did not appear to decrease ovarian cancer mortality in participants
with a family history of breast or ovarian cancer. Secondary endpoints,
however, showed notable differences. Significantly fewer patients were
diagnosed with advanced stage disease in the screening arm; and survival
was significantly improved. Further investigation is warranted to
assess screening efficacy in women at increased risk.
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