Harms Outweigh Benefits From Screening Women at Average Risk for Ovarian Cancer
Kristie L. Kahl
Should women who are not known to have a hereditary risk for ovarian cancer get screened? The US Preventive Services Task Force (USPSTF) says no.
The USPSTF reviewed evidence from three “good-quality” studies on the benefits and harms of ovarian cancer screening in asymptomatic women with no known high risk for the disease. In particular, researchers on the task force evaluated ovarian cancer mortality, quality of life, false-positive rates, surgery and surgical complication rates, and psychological effects from screening.
The task force found adequate evidence that screening with transvaginal ultrasound or testing for the serum tumor marker cancer antigen-125 (CA-125), or both, does not reduce ovarian cancer mortality.
More importantly, most women who have positive screening test results do not have ovarian cancer, or in other words, many women end up having false-positive results. This can lead to unnecessary surgical interventions in a group of women who do not have cancer.
Ultimately, in a reiteration of its 2012 recommendation, they concluded with “at least moderate certainty” that the harms of screening outweighed the benefits.
“Given the lack of mortality benefit of screening, and the moderate to substantial
harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concludes with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening
is negative,” the task force wrote.
A draft version of this recommendation was issued in July 2017, and available for public comment. Many voiced concerns regarding the aggressive nature of ovarian cancer, suggesting that any screening to detect the malignancy earlier is needed. However, the task force noted that, although screening tests are needed to accurately diagnose ovarian cancer, those that are currently available are unable to do so without causing harm.
From 2010 to 2014, the age-adjusted incidence of ovarian cancer was 11.4 cases per 100,000 women a year. Despite its low incidence, ovarian cancer is the fifth most common cause of cancer death among U.S. women and the leading cause of death from a gynecologic cancer, claiming the lives of approximately 14,000 women a year.
Ovarian cancer typically occurs in women aged 45 years and older, and most often, shows few to no symptoms until the cancer has progressed into later stages. These symptoms can include abdominal pain or pressure, feeling bloated, or feeling the size of the abdomen increase, according to an accompanying Patient Page, written by Jill Jin, M.D. MPH, from Northwestern University Feinberg School of Medicine.
Jin noted there can be potential benefits seen from screening. “The potential benefit of screening for ovarian cancer is finding the cancer earlier, given that it generally does not cause symptoms in early stages,” she explained.
Despite this, she added that unnecessary surgery confirms the USPSTF’s reasoning for recommending against screening in women who are not at high risk.
“Because diagnosis of suspected cancer is generally confirmed by surgery to remove one or both ovaries (rather than by biopsy), the potential harm of unnecessary surgical removal of the ovaries in women who do not have cancer is substantial,” she wrote.
So now what? Stephanie V. Blank, M.D., from the Department of Obstetrics, Gynecology and Reproductive Sciences at Icahn School of Medicine at Mount Sinai, agrees with these recommendations, but proposed options for women who still have concerns.
Most importantly, women should have open dialogue with their physicians. “A woman who believes she is at increased genetic risk for cancer should discuss this with her doctor and together they can decide whether genetic testing and/or screening is appropriate,” Blank said in commentary issued to CURE.
“If a woman thinks she is at increased genetic risk for ovarian cancer she should consider genetic counseling and testing. A positive test would allow her to take steps to actually save her life, not only screening but prevention.”
In addition, Blank noted that women need to be their own advocates if they do in fact feel symptoms associated with ovarian cancer.
“if a woman has symptoms of ovarian cancer (eg bloating, trouble eating, pelvic or abdominal pain, urinary frequency) she should demand this testing,” she added. “Because screening for ovarian cancer is not effective it is extremely important that women be aware of the symptoms of ovarian cancer and advocate for themselves.”