Abstract and Introduction
New data from the University of Kentucky offer hope, although positive predictive value is still too low.
Although ovarian cancer is the most lethal gynecologic malignancy in the U.S., early disease is highly curable; thus, interest in screening strategies that can lower ovarian cancer mortality remains high. In the University of Kentucky Ovarian Cancer Screening Trial, researchers screened asymptomatic women with vaginal ultrasound. When imaging was abnormal (ovarian volume >20 cm3 in premenopausal women or >10 cm3 in postmenopausal women, or presence of cystic tumors with solid areas and papillary projections), ultrasound imaging was repeated in 4 to 6 weeks. If abnormal findings persisted, serum CA 125 assessment was performed. Surgery was recommended for women with persistent solid or complex ovarian masses and in those with cystic ovarian masses accompanied by elevated CA 125 levels. Women with screen-detected ovarian cancer were compared with unscreened women with ovarian cancer diagnoses who were identified though tumor registries.
In all, 37,293 women (mean age, 57; 22% with family histories of ovarian cancer) underwent a mean of five scans each from 1987 to 2011. Surgery was performed in 523 women with persistent ovarian masses on imaging; of these women, ovarian cancer was detected in 76 (47 of whom had invasive epithelial tumors) and ovarian pathology was benign in 447. Ovarian cancer was diagnosed within 12 months of a negative screen in 12 women. At surgery, the proportion of women with invasive stage I or II epithelial tumors was 70% among women with screen-detected tumors and 27% among women with registry-identified tumors. Five-year disease-free survival for women with stage I and stage II cancers was 95% and 77%, respectively, and did not vary substantially between screen-detected and registry-identified cancers. Five-year disease-free survival for all screen-detected and registry-identified cancers treated at the University of Kentucky Cancer Center was 85% and 54%, respectively.
Journal Watch © 2011 Massachusetts Medical Society