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USPSTF 2018 recommends against screening for ovarian cancer in asymptomatic women (D recommendation)
Clinical Question
Should primary care clinicians screen for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome?
Bottom line
The US Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome (D recommendation). The task force found adequate evidence that screening does not reduce ovarian cancer mortality, and the harms from screening are at least moderate. This updated recommendation is consistent with the previous recommendation in 2012 (D recommendation). 2b
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
In this updated review the USPSTF evaluated current evidence assessing the benefits and harms of screening for ovarian cancer among average-risk women. The annual age-adjusted incidence of ovarian cancer is 11.4 cases per 100,000 women per year. The task force found adequate evidence from 3 randomized trials (N = 293,038) that screening with transvaginal ultrasound, serum CA-125, or a combination of both does not reduce ovarian cancer mortality. In addition, screening can result in significant harms to patients, including producing many false-positive results, which may lead to unnecessary surgery and/or psychological harm in women who do not have cancer. The task force also recommends that women with a family history that indicates they are at a genetic risk for ovarian cancer be referred for genetic counseling. The American College of Obstetricians and Gynecologists, the American Cancer Society, and the American Academy of Family Physicians also recommend against screening for ovarian cancer in asymptomatic women.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Good poem
Good to know
But it is rather depressing that there isn’t something even vaguely reliable. Not least because newspapers, magazines, TV, and the internet have been raising expectations in the population,for decades, that they should be screened and that the test they should ask for is CA-125.
This topic of ovarian cancer is not nearly as neat and organized as this topic would suggest. Consider cases with advanced ovarian cancer but with only peritoneal masses and an acceptable Ca-125 but no ovarian masses! Furthermore in 2 cases of sisters, each with same diagnosis of Primary carcinoma of the peritoneum bordering on serous adenocarcinoma of the ovary, each with acceptable Ca-125, and no ovarian masses on ultrasound but large Omental tumours and one with a metastatic pleural effusion. Both had negative genetic testing with current 17 genetic tests, thus allowing only the term of "familial cluster" without genetic influence.
This disease can present very subtly as far as symptoms go then end up being diagnosed too late in the course of this disease! CT imaging has difficulty with assessment of ascites to further complicate the issue. What we have available for screening in 2018 is far from ideal but to not screen implies a very thorough review of symptoms that will usually be painless but may demonstrate a gradually increasing abdominal abdominal girth often attributed to GI issues such as constipation. We need better screening tools.
If a woman is specifically requesting this screening,
due to concerns based on lived experience with friends or extended family - that should be considered, too.
I believe it is actually dangerous to practice population-
health on individuals. A person is not a number.
Ovarian cancer needs more research