Screening for Ovarian Cancer
Routine screening for ovarian cancer is not recommended for asymptomatic women, including those with a family history, because screening does not reduce mortality and causes substantial harms from false-positive results and unnecessary surgeries.
Primary Recommendation
The USPSTF gives a Grade D recommendation against screening for ovarian cancer in asymptomatic women. 1 This applies to both average-risk women and those with family history of ovarian cancer. 1
Why Screening Is Not Recommended
The evidence against screening is clear and consistent:
- No mortality benefit exists - No screening test, including CA-125, transvaginal ultrasound, or pelvic examination, reduces death from ovarian cancer. 2
- High false-positive rate - Only 2% of positive screening tests represent actual cancer in average-risk women, meaning 98% of women with positive results do not have cancer. 2, 1
- Substantial harms outweigh any potential benefits - The invasive nature of diagnostic testing after positive screens leads to significant morbidity. 2
Quantifying the Harms
For every 10,000 women screened annually: 2, 1
- 300-350 women without cancer are recalled for further testing, causing anxiety and distress
- 20-65 women without cancer undergo unnecessary surgery each year
- Only 4 additional cancers would be detected at most
- Only 1.5 additional 5-year survivors would result (even with optimistic assumptions)
High-Risk Women
Even women with family history should not undergo routine screening. 1 However, these women require a different management approach:
Define High-Risk Family History
High-risk is defined as: 1
- Two or more first- or second-degree relatives with ovarian cancer
- Combination of breast and ovarian cancer in the family
- Ashkenazi Jewish ancestry with one first-degree relative (or two second-degree relatives on same side) with breast or ovarian cancer
Appropriate Management for High-Risk Women
Refer for genetic counseling rather than screening, particularly when: 1
- Mother diagnosed at young age
- Additional family history of breast cancer
- Ashkenazi Jewish descent
- Other cancers suggesting Lynch syndrome
Discuss proven risk-reduction strategies: 1
- Oral contraceptive use (reduces risk by approximately 50%) 3
- Pregnancy and breastfeeding history
- Bilateral tubal ligation
- Risk-reducing salpingo-oophorectomy (only for confirmed BRCA1/BRCA2 or Lynch syndrome mutation carriers)
What to Do Instead of Screening
Maintain clinical vigilance for symptoms rather than screening. 2, 1 The American College of Obstetricians and Gynecologists recommends remaining alert for early signs and symptoms: 2, 1
- Abdominal or pelvic pain
- Unexplained weight loss
- Bloating or increased abdominal size
- Early satiety
When symptoms are present, evaluate with pelvic examination, CA-125, or ultrasound. 2 This is diagnostic evaluation, not screening.
Common Pitfalls to Avoid
- Do not order "routine" CA-125 or transvaginal ultrasound in asymptomatic women, even with family history - this causes more harm than benefit. 2, 1
- Do not confuse family history with genetic mutation - family history alone does not justify screening; it justifies genetic counseling. 1
- Do not perform annual pelvic examinations for ovarian cancer screening - these are ineffective for detecting ovarian cancer. 3, 4
Consensus Across Organizations
All major medical organizations agree: 2