From the Guidelines
Ovarian cancer screening is not recommended for nonsmoking Asian women without specific risk factors, as the current evidence suggests that the harms of screening outweigh the benefits. The most recent and highest quality study, published in 2023 1, emphasizes the importance of risk reduction and screening in hereditary breast-ovarian cancer syndromes, but does not support routine screening for the general population. According to the US Preventive Services Task Force (USPSTF) recommendations from 2013 1, screening for ovarian cancer in asymptomatic women without known genetic mutations is not recommended, with a Grade D recommendation.
Key Considerations
- Women with increased risk factors, such as BRCA1/BRCA2 gene mutations or strong family history of ovarian or breast cancer, should consider genetic counseling and may benefit from more intensive surveillance 1.
- The lack of effective screening recommendations stems from the relatively low prevalence of ovarian cancer in the general population and the high false-positive rates of available tests, which can lead to unnecessary invasive procedures 1.
- Awareness of family history and recognition of potential symptoms, such as bloating, pelvic pain, difficulty eating, or frequent urination, remain the most important strategies for early detection of ovarian cancer in Asian women.
Screening and Risk Reduction
- Intensified screening should start at age 30, or 5 years younger than the youngest family member with breast cancer, in the presence of a BRCA1, BRCA2, or PALB2 pathogenic variant 1.
- Annual screening intervals are recommended, except for BRCA1 where 6-monthly screening should be considered 1.
- There is no evidence to support continued routine breast imaging after risk-reducing mastectomy, but a baseline MRI in the first year after surgery to evaluate the amount of residual breast tissue is reasonable 1.
From the Research
Ovarian Cancer Screening among Nonsmoking Asian Population
- There is limited information available on ovarian cancer screening specifically among nonsmoking Asian populations.
- However, studies have been conducted on ovarian cancer screening in general populations and high-risk women, including those with BRCA1/2 mutations.
Screening Methods and Effectiveness
- The most commonly used screening methods for ovarian cancer are transvaginal ultrasound (TVU) and serum CA-125 measurement 2, 3, 4, 5.
- These methods have been shown to have low sensitivity and specificity for detecting early-stage ovarian cancer, particularly in high-risk women 4, 6, 5.
- A study found that the combination of CA-125 and TVU had a sensitivity of 40% and a positive predictive value of 40% for detecting ovarian cancer 4.
- Another study found that annual gynecological screening of women with a BRCA1/2 mutation did not effectively prevent advanced-stage ovarian cancer 5.
Recommendations for Screening
- General population screening for ovarian cancer is not recommended due to the low incidence of the disease and the lack of effective screening methods 3.
- For high-risk women, including those with BRCA1/2 mutations, prophylactic bilateral salpingo-oophorectomy (pBSO) is recommended after childbearing is complete to prevent 90% of ovarian cancers 3.
- However, there is still a residual risk of primary peritoneal cancer after pBSO, particularly for BRCA1 carriers 2.
Future Directions
- Research is ongoing to develop new screening tests and biomarkers for ovarian cancer, which may improve the effectiveness of screening in the future 6.