'No' Yet Again to Routine Ovarian Cancer Screening

Roxanne Nelson, BSN, RN

July 18, 2017

New draft guidelines from the US Preventive Services Task Force (Task Force) recommend against screening for ovarian cancer in women who have no signs or symptoms.

"The Task Force found that screening women without signs or symptoms for ovarian cancer does not decrease the number of deaths from the disease and may lead to unnecessary surgeries," said Task Force member Maureen Phipps, MD, MPH, in a statement.

"Therefore, the Task Force recommends against screening for ovarian cancer in women who have no signs or symptoms and who are not at high risk for ovarian cancer," she said.

This recommendation applies only to asymptomatic women who are not deemed to be at a higher risk of developing ovarian cancer. It does not pertain to woman who are known to be at higher risk, such as those who harbor BRCA mutations.

Overall, the Task Force found adequate evidence that routine screening in asymptomatic women or in those not deemed to be at high risk did not decrease ovarian cancer mortality.

There was also evidence that the harms associated with screening were at least moderate and in some cases could be substantial and that there was "at least moderate certainty" that the potential harms outweighed the potential benefits. These harms include false positive results, which could lead to diagnostic surgery and potential removal of the ovaries and fallopian tubes.

The recommendations in the new draft paper are consistent with the previous recommendation for ovarian cancer, which was issued in 2012 and gave routine screening a grade D recommendation (ie, not recommended).

The 2012 report, in turn, echoed a 2004 recommendation made by the Task Force, which found that "the potential harms outweighed the potential benefits of screening."

No Mortality Benefit

In their review of available data, the Task Force identified three good-quality studies that evaluated the effect of annual screening in asymptomatic women who were not deemed to be at a high risk of developing ovarian cancer. None of the findings demonstrated that screening significantly reduced ovarian cancer mortality.

The United Kingdom Collaborative Trial of Ovarian Cancer Screening, which is the largest and most recent trial, was conducted after the initial 2012 recommendations were issued. It confirmed the findings from the earlier Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial that screening does not decrease mortality in this population.

Data from the three studies, along with a fourth fair-quality study that examined quality of life and the psychological harms of screening (Quality of life, Education, and Screening Trial) were analyzed to determine the risks associated with screening.

Calculated false positive rates of the various screening methods ranged from 4.2% to 44.2%; from 0.2% to 3.2% of patients eventually underwent surgery. Among this group, major surgical complications were observed in 0% to 15%.

In Sync With Other Groups

Ovarian cancer screening for the general population is not recommended by any of the major medical and public health organizations. The American College of Obstetricians and Gynecologists, the American Cancer Society, and the American College of Radiology do not recommend screening for women at average risk. The American Academy of Family Physicians (AAFP) also recommended against screening in 2012; the AAFP is currently reviewing this recommendation.

The Task Force's draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website.

Comments can be submitted online from July 18 through August 14.

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