Should we start screening women for ovarian cancer?

The answer is no.

Besides the fact that the USPSTF already recommends against ovarian cancer screening, MedPage Today reports a study concluding that screening led to a high rate of unnecessary surgery.

During four years of screening with a transvaginal ultrasound and the CA 125 biomarker , “the surgery-to-cancer ratio was 19.5:1,” meaning that almost 20 surgeries would be needed for every case of ovarian cancer detected. And furthermore, of the ovarian cancers, 72 percent were already at an advanced stage.

There is no doubt that ovarian cancer is deadly. However, the current means of early prevention clearly aren’t good enough. Until they are, we are subjecting women to a host of unnecessary ovarian surgeries which, in the end, may not be life saving anyways.

Comments

Anonymous
i do agree with this, but do we do this same literature for rectal exams and psa’s. Especially if the treatment doesn’t work. Personally i don’t really want a rectal exam, so I would be fine with not every getting one…
ToolboxMD
That brings up another topic. Don’t you think the field of Gyn-oncology is really not impacting survival in most patients. Do we really need that specialty?
Mary Ellen
If the results of the CA 125 blood test and ultrasound look suspicious, the next step should be a CT or PET scan for further analysis. Then if a mass or metastatic activity is detected through the scans, a surgical biopsy would be attempted. In my case the biopsy was positive, so major surgery commenced right afterward. These were the steps I took which revealed stage 1 cancer in one ovary. The other was removed prophalactically. I’m so grateful my doctor took my complaint of abdominal pain seriously and didn’t throw me under the bus by denying me these screening tools with the justification that there was only a 1 in 20 chance it would be cancer.
Anonymous
Toolbox, my understanding of the literature is that surgery & staging by a gynecologic oncologist is actually the one thing that makes the greatest difference in length of survival among ovarian cancer patients, because they do a far better job of debulking than general surgeons and gynecologists.
Diora
Mary Ellen ordering tests in case of symptoms like your pain is different from screening people who have no symptoms. In the latter case a number of false positives increases while the number of real positives decreases. The study doesn’t say pain shouldn’t be investigated, it says that screening people who have no symptoms may hurt more women than it may help (and that it’s not clear if it’ll help anybody).
The problem is these additional tests you mention have false positives as well. Additionally, screening always increases chance of overdiagnosis – finding early “cancers” (i.e. look like cancer under the microscope) that would never progress in one’s lifetime or even regress on its own but today no tests can tell the difference. You’ll say – it’s less of a problem than missing a real cancer, except for treatment has risks as well. Is one woman’s losing ovaries (and suffering all the risks that come with it) worse another woman’s life being saved? What about 20 women losing their ovaries? Keep in mind that living without ovaries increases risk of heart disease as well as osteoporosis. It may be a small price to pay if you had cancer that was destined to spread but what about if someone could’ve lived her life and died at the age of 90 without even knowing she had cancer?
All cancers aren’t equal. Some are very aggressive so no amount of screening will help. Some are indolent and never spread or regress on its own. Some grow slowly so even when they are detected later – like in your case when you had symptoms – they are still treatable. Whether or not screening helps depends a lot if for a particular cancer there is a group of cancers that grow fast enough to spread between the time they are detected by a test and the time they cause symptoms yet slow enough that screening can catch them during this time. It is questionable if in case of ovarian cancer this group even exists, as well as how large it is if it does.

Should we start screening women for ovarian cancer?

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