HERA Board Member Summarizes USPSTF Findings

October 11, 2012

Sarah Adams was recently elected to the HERA Board. As a gynecologic oncologist, her expertise is very much appreciated. Welcome, Sarah!

Risks associated with ovarian cancer screening outweigh benefits in low-risk women

By Sarah Adams, MD
Assistant Professor, Gynecologic Oncology
University of New Mexico Cancer Center
Alburquerque, NM

Last month, the US Preventive Services Task Force (USPSTF) issued a statement recommending against routine screening for ovarian cancer in asymptomatic women. In reviewing the data from several large studies, the committee was concerned that the risks associated with screening outweighed the benefits in low-risk women, as many women underwent surgery, but few were found to have cancer. The USPSTF concluded that there is currently no effective screening tool for early detection of ovarian cancer.

Importantly, these recommendations do not apply to women who have symptoms that may be associated with ovarian cancer, including pelvic or abdominal pain, urinary urgency or frequency, increased abdominal size or bloating, difficulty eating and feeling full. Any woman reporting the onset of these symptoms within the past year, or their occurrence more than 12 days per month, should talk with her doctor about referral to a gynecologic oncologist.

This recommendation also does not apply to women with a family history of cancer, or women who are known to have genetic mutations associated with a higher risk of ovarian cancer. Women with BRCA1 and BRCA2 germline mutations, women diagnosed with Lynch syndrome (hereditary nonpolyposis colon cancer, or HNPCC), women with a family history of ovarian cancer, and women diagnosed with pre-menopausal breast cancer are at increased risk of developing ovarian cancer and should consult with a genetic counselor to help assess their risk. Women with family histories of the following additional cancers should also be referred for genetic counseling: colon, endometrial, fallopian tube and peritoneal cancer.

While this document highlights the lack of successful screening protocols for early ovarian cancer, there are opportunities to reduce the likelihood that a woman will develop ovarian cancer that are well-established. In particular, woman at increased risk of ovarian cancer may opt to undergo risk-reducing surgery to remove her ovaries and fallopian tubes. This can often be done in a minimally invasive manner, and has been demonstrated to reduce the risk not only of ovarian cancer, but also of breast cancer in high risk groups. For women who may desire future fertility, or who wish to avoid surgery, oral contraceptives can also be used to reduce the risk of developing ovarian cancer, with a protective effect that extends for several years after use. Finally, both pregnancy and breast feeding have been associated with lower rates of ovarian cancer.

In summary, there is no effective screening test for ovarian cancer at this time. Efforts to detect early tumors with blood tests or trans-vaginal ultrasound have resulted in a high number of women undergoing surgery for benign conditions, and have failed to detect early stage disease or to reduce mortality due to this cancer. More research is needed to improve our understanding of early events in ovarian cancer development, and to identify diagnostic markers associated with tumor growth, as early detection remains the best opportunity to achieve a cure for this disease.

Full text of the USPSTF statement is available at: http://www.uspreventiveservicestaskforce.org/3rduspstf/ovariancan/ovcanrs.htm

Summary of Recommendation
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer.
Rating: D Recommendation.
Rationale: The USPSTF found fair evidence that screening with serum CA-125 level or transvaginal ultrasound can detect ovarian cancer at an earlier stage than it can be detected in the absence of screening; however, the USPSTF found fair evidence that earlier detection would likely have a small effect, at best, on mortality from ovarian cancer. Because of the low prevalence of ovarian cancer and the invasive nature of diagnostic testing after a positive screening test, there is fair evidence that screening could likely lead to important harms. The USPSTF concluded that the potential harms outweigh the potential benefits.

Comments

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One comment

  1. October 12, 2012 at 5:15 pm

    Jill S says:

    Thank you for making this so clear Sarah! What percentage of women that get oc do not have have symptoms, a family history of cancer, specific mutations, or an increased risk?

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