COMMENTARY

Evidence Says No, but Docs Do It Anyway

Maurie Markman, MD

Disclosures

March 08, 2012

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I am Dr. Maurie Markman from the Cancer Treatment Centers of America. I want to briefly discuss a very important but quite concerning report that appeared in the Annals of Internal Medicine,[1] titled "Vignette-Based Study of Ovarian Cancer Screening: Do US Physicians Report Adhering to Evidence-Based Recommendations?"

In this analysis, which looked at 3200 physicians randomly sampled to participate in the survey, approximately 28% of the respondents reported nonadherence to screening recommendations for women at low risk for development of ovarian cancer.

The really concerning part about the exercise is that there is very clear evidence today, based on a landmark randomized controlled trial conducted by the National Cancer Institute and reported in JAMA,[2] that showed that not only was screening for ovarian cancer of no value in reducing mortality from the disease, but in fact there was potential for very serious harm. Women would undergo potentially quite morbid procedures or surgeries that were completely unnecessary and without any evidence of benefit. Yet this particular analysis demonstrates that screening remains common.

There are a variety of reasons for this, including concerns of doctors about malpractice. It is easier to obtain a test if a patient asks for it than to say no. Also, well-intentioned individuals and groups continue to stress the value of obtaining screening by ultrasound and CA-125 levels, even though the evidence against this is strong. Finally, continuing statements in the literature suggest a value of finding ovarian cancer early, even though very strong evidence now suggests that we cannot do this.

For example, the author of an unsigned commentary in Lancet Oncology,[3] which just appeared in the February 13, 2012, issue, called "Ovarian Cancer, Breaking the Silence," made the statement that less than a third of women are diagnosed with early-stage disease for which survival at 5 years is 90%, indicating that early diagnosis and treatment are central for reducing mortality. These kinds of statements are appearing in a journal as excellent as Lancet Oncology, with no data to support them, and in fact the opposite is true on the basis of the evidence we have today.

This is an important study in the Annals of Internal Medicine. Oncologists, general physicians, and family doctors need to be very aware that today there is no evidence that screening for ovarian cancer can favorably influence outcomes in this difficult illness and, in fact, may have serious harm.

I thank you for your attention, and I encourage you to read this important paper.

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