From the Guidelines
There is no recommended routine screening program for ovarian cancer in the general population, as current screening tests have not been proven to reduce mortality. The most recent and highest quality study, the PLCO Cancer Screening Trial, found that screening average-risk, asymptomatic women with serum CA-125 testing and transvaginal ultrasonography does not reduce ovarian cancer deaths 1. This study, which included over 78,000 women, found that while there was a non-statistically significant increase in ovarian cancer cases diagnosed in the screening group, there was no difference in either stage at diagnosis or ovarian cancer death rate.
Some key points to consider:
- The tests that do exist, such as transvaginal ultrasound and the CA-125 blood test, are not accurate enough for general screening and can produce many false positives, leading to unnecessary procedures and anxiety.
- These tests are typically only used for women at high risk due to genetic factors, such as BRCA1/BRCA2 mutations, or strong family history of ovarian cancer.
- For high-risk individuals, doctors may recommend periodic transvaginal ultrasounds and CA-125 testing, though even in these cases, the benefit remains unproven.
- The challenge with ovarian cancer screening is that early-stage disease rarely causes symptoms, and by the time symptoms appear, the cancer has often advanced.
It's worth noting that some guidelines, such as those from the American Cancer Society, suggest that women with a high risk of epithelial ovarian cancer, such as those with a very strong family history of the disease, may be screened with transvaginal ultrasound and CA-125 1. However, the evidence for this is not strong, and the benefits and harms of screening in these high-risk individuals are still uncertain. Ultimately, women should discuss their individual risk factors with their healthcare provider to determine if any monitoring is appropriate for their situation.
From the Research
Ovarian Cancer Screening Programs
- There are no widely recommended screening programs for ovarian cancer in the general population due to the low prevalence of the disease and the limited sensitivity and specificity of current screening tests 2, 3, 4, 5.
- The most commonly used screening tests for ovarian cancer are transvaginal ultrasound and the CA-125 blood test, but these tests have limitations in terms of sensitivity and specificity 2, 4, 6.
- Some studies have investigated the use of multimodal screening, including the combination of transvaginal ultrasound and CA-125 testing, but none have demonstrated a mortality benefit in the general population 3, 4.
Screening for High-Risk Women
- Women at high risk of ovarian cancer, such as those with a strong family history of the disease or with BRCA1 or BRCA2 mutations, may benefit from more frequent surveillance, including transvaginal ultrasound and CA-125 testing every 3-4 months 3, 5.
- Risk-reducing salpingo-oophorectomy (RRSO) is recommended for women at high risk of ovarian cancer, and can decrease the incidence and mortality of the disease 3.
- Other preventive measures, such as risk-reducing early salpingectomy and delayed oophorectomy (RRESDO), are being investigated, but are currently only recommended within the context of a research trial 3.
Future Directions
- Research is ongoing to develop new diagnostic tests and novel biomarkers for ovarian cancer screening, which may improve the accuracy and outcomes of screening 3, 4, 6.
- Population testing and longitudinal multiple marker strategies are being explored as potential approaches to identify women at high risk of ovarian cancer 3.