What are the recommendations for ovarian cancer screening?

Ovarian Cancer Screening Recommendations

Routine screening for ovarian cancer is not recommended for asymptomatic women without known genetic mutations that increase risk of ovarian cancer. 1, 2

Current Evidence and Recommendations

The U.S. Preventive Services Task Force (USPSTF) has issued a "D" recommendation against routine screening for ovarian cancer in asymptomatic women, concluding that the harms of screening outweigh the potential benefits 1, 2. This recommendation applies to women without known genetic mutations that increase their risk of ovarian cancer.

Rationale Against Routine Screening

1. Lack of mortality benefit:

   • Screening with serum CA-125 or transvaginal ultrasound can detect ovarian cancer at earlier stages but has not been shown to reduce mortality from ovarian cancer 1
   • The USPSTF found adequate evidence that screening does not reduce ovarian cancer mortality 2

2. High false-positive rates:

   • In women at average risk, the positive predictive value of an abnormal screening test is approximately 2% (meaning 98% of positive results are false positives) 1
   • A British Health Technology Assessment study estimated that screening 10,000 women would result in 300-350 women without cancer being recalled for further assessment 1

3. Potential harms of screening:

   • Unnecessary surgeries (20-65 women without cancer would undergo surgery per 10,000 screened) 1
   • Psychological distress and anxiety in otherwise healthy women 1
   • Surgical complications in women who do not have cancer 2

Special Considerations for High-Risk Women

Women with increased risk factors should be managed differently:

1. Who is considered high-risk:

   • Women with BRCA1 and BRCA2 genetic mutations
   • Women with Lynch syndrome (hereditary nonpolyposis colon cancer)
   • Women with strong family history of ovarian cancer 1, 3

2. Management of high-risk women:

   • Referral for genetic counseling is appropriate 1, 3
   • If genetic mutations are identified, bilateral salpingo-oophorectomy can be considered for risk reduction 3
   • Some experts suggest that high-risk women be referred to academic health centers for regular combination screening 1

Common Pitfalls in Ovarian Cancer Screening

1. Physician non-adherence to recommendations:

   • Despite evidence against screening, approximately 28% of physicians report non-adherence to recommendations against screening for low-risk women 4
   • 33% of physicians incorrectly believe that TVU or CA-125 are effective screening tests 4

2. Misunderstanding of test limitations:

   • CA-125 and transvaginal ultrasound have limited sensitivity and specificity for early-stage disease
   • The low prevalence of ovarian cancer in the general population leads to very low positive predictive values 5

3. Confusing screening with diagnostic evaluation:

   • Symptoms such as abdominal or pelvic pain and unexplained weight loss should be evaluated with pelvic examination, CA-125, or ultrasound, but this is diagnostic evaluation, not screening 1, 3

Risk Reduction Strategies

For both average and high-risk women, long-term hormonal contraceptive use reduces ovarian cancer risk by approximately 50% 3.

Consensus Among Medical Organizations

No medical organization recommends routine screening for ovarian cancer in asymptomatic average-risk women:

• U.S. Preventive Services Task Force (USPSTF) recommends against screening 1, 2
• American Cancer Society (ACS) does not recommend screening for women without strong risk factors 1
• American College of Obstetricians and Gynecologists (ACOG) does not recommend screening but suggests vigilance for early signs and symptoms 1
• Canadian Task Force on Preventive Health Care (CTFPHC) recommends against screening asymptomatic women 1

Current research continues to explore potential screening strategies, but at present, the evidence clearly shows that routine screening for ovarian cancer in the general population causes more harm than benefit.