Editorials: What Women and Their Physicians Need to Know About the UKCTOCS Study and Ovarian Cancer Screening

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Editorials: What Women and Their Physicians Need to Know About the UKCTOCS Study and Ovarian Cancer Screening - American Family Physician

June 2016
 

Am Fam Physician. 2016 Jun 1;93(11):903-904.

  Related article: Diagnosis and Management of Ovarian Cancer

  Related editorial: Screening for Ovarian Cancer - More Hype Than Hope?

In February 2016, the Ovarian Cancer Research Fund Alliance convened a group of 25 scientists, clinicians, and advocates to meet at the Banbury Center, Cold Spring Harbor Laboratory, to discuss the recent results from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and implications for clinical practice and public health.
Ovarian cancer is a relatively rare type of cancer that affects approximately 1.5% of U.S. women during their lifetime, but it is the fifth most common cause of cancer death among women.1 The five-year survival rate is only about 45% because most women present with advanced-stage disease.1 There has not been an accepted early detection test because of a lack of evidence that any screening approach reduces death from ovarian cancer. At the time of the conference, no organization had issued a guideline recommending screening for ovarian cancer in women not at increased risk.
The current recommendations against screening for ovarian cancer are based on the large U.S. prospective randomized Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.2 The PLCO trial demonstrated that an annual cancer antigen (CA) 125 measurement (using a fixed cutoff value for a positive test result) and ultrasonography were not associated with a reduction in mortality from ovarian cancer. Furthermore, screening was associated with significant harms resulting from surgeries that were triggered by false-positive findings.
In December 2015, the results of the UKCTOCS trial were reported in The Lancet.3 This landmark study included approximately 200,000 healthy postmenopausal women, of whom one-half were randomized to no screening, one-fourth were randomized to receive annual pelvic ultrasonography, and one-fourth were randomized to multimodal screening (MMS). In contrast to the PLCO approach, MMS involves a risk of ovarian cancer algorithm (ROCA) that assigns a level of risk based on an individual woman's CA 125 levels and changes over time combined with her age and known risk factors for ovarian cancer. Based on these findings, further CA 125 testing and ultrasonography may be required.....