COMMENTARY

Screening for Ovarian Cancer: Any Survival Benefit?

Sandra A. Fryhofer, MD

Disclosures

October 10, 2011

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Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic is a new report in The Journal of the American Medical Association: "Effect of screening on ovarian cancer mortality."[1] Here's why it matters.

Every year more than 21,000 women are diagnosed with ovarian cancer, and more than 15,000 of them die. Ovarian cancer is the deadliest reproductive carcinoma. Stage I cancer, which is confined to the ovary, has a 92% survival rate, but most ovarian cancers are advanced when diagnosed, which carry a 5-year survival of only 30%. That's why the concept of screening and early diagnosis is so appealing. Many physicians order serial CA-125 levels along with transvaginal ultrasounds, but is this effective?

The 13-year study from the PLCO trial indicates that it isn't. The trial included nearly 80,000 women ranging in age from 55 to 74 years. The women were randomized to receive either 6 years of annual screenings with CA-125 levels along with transvaginal ultrasound for 4 years or to regular usual care. The results were disappointing. The difference in survival between the 2 groups was not statistically significant. Furthermore, the women in the screened group were subjected to more medical interventions, more oophorectomies, and 20% of these women had surgical complications.

In summary, screening for ovarian cancer with serial CA-125 and transvaginal ultrasounds is not effective. There were more false positive results, more surgeries, and more surgical complications but no reduction of death. In this study, screening offered no advantage. So, more research is needed to find the optimal way to find ovarian cancers early and save lives. For Medicine Matters, I'm Dr. Sandra Fryhofer.

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