The number of surgeries required to identify one ovarian cancer in this study was lower than that in the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer trial (7 vs. 19), and the positive predictive value of vaginal ultrasound screening was higher (14% vs. 5%; JW Womens Health Jun 16 2011). The authors attribute their better screening performance to a strict protocol in which women with simple ovarian cysts <10 cm in diameter or septated cysts (ovarian masses that were not associated with malignancy) underwent surveillance rather than surgery. Nonetheless, the authors acknowledge that the positive predictive value calculated from this trial is unacceptably low for routine screening of the general population. Editorialists note that the favorable outcomes of this trial might reflect a combination of lead time and healthy-volunteer bias rather than a direct effect on mortality, and suggest waiting to see if updates from the randomized U.K. Collaborative Trial (JW Womens Health Apr 16 2009), due to be published in 2015, show mortality reductions with screening.
Journal Watch © 2011 Massachusetts Medical Society