Women should not be screened for ovarian cancer unless they have symptoms, the leading US task force has declared.
Although the notoriously hard-to-spot disease kills 14,000 a year as it is often diagnosed too late, a panel has found that routine screening would lead to too many false positives.
Publishing the first update since 2012, the US Preventive Service Task Force wrote in JAMA that a pro-screening policy could lead to unnecessary life-altering surgery for many women.
Experts say the conclusion merely shows our lack of progress in the last three decades to identify an effective screening method for the life-threatening disease.
Although the notoriously hard-to-spot disease kills 14,000 a year as it is often diagnosed too late, a panel has found that routine screening would lead to too many false positives
Dr Karen H Lu, MD, a gynecologist at the University of Texas, wrote in an editorial for JAMA: ‘With such a clear unmet need and research commitment, it is important to ask the following questions: Why has it not been possible to delineate an effective screening strategy for ovarian cancer? Is an effective strategy close at hand?’
EXPLAINED: OVARIAN SCREENING & POLICY
WHAT ARE THE PROS AND CONS OF 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.
However, three randomized trials have found that screening with ultrasound, CA-125 testing, or both did not decrease the overall death rate due to ovarian cancer.
Furthermore, current screening techniques of both ultrasound and CA-125 testing result in high rates of false-positive findings. These false positives lead to the potential harm of unnecessary treatment.
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.
WHAT IS THE POLICY ON SCREENING?
The USPSTF concludes with moderate certainty that the potential harms of screening for ovarian cancer outweigh the potential benefits.
The ovaries are part of the reproductive system in women, responsible for making and storing eggs.
Ovarian cancer, which mainly affects women over the age of 45, is the fifth leading cause of cancer death among US women.
Symptoms tend not to emerge until the later stages, when the cancer has spread to other organs and is harder to treat.
Even then, these symptoms can masquerade as other less serious conditions. They include abdominal pain or pressure, feeling bloated, or feeling the size of the abdomen increase.
It can be screened for using an ultrasound to look for any abnormalities in the ovaries.
Clinicians can also carry out a blood test to look for a tumor marker called CA-125 that is associated with ovarian cancer.
The task force has advised against such screening (blood test and ultrasound) for women who do not have symptoms, even if they have a history of ovarian cancer. They do, however, recommend screening for women with BRCA1 which increases cancer risk – so-called the ‘Jolie gene’ since Angelina Jolie revealed she is a carrier.
OBGYNs are still urged to carry out routine pelvic examinations to check for enlarged organs or tenderness in all patients.
If a woman is diagnosed with a tumor, treatment can include surgery to remove the ovaries and uterus, and occasionally chemotherapy.
Writing in JAMA, Dr Lu said we have gathered significant evidence since the mid-90s that certain methods of screening do catch the illness early.
‘First, it seems likely that effective, early detection of ovarian cancer will involve a two-stage strategy that includes a first-stage, inexpensive test (for example, a blood test) followed by an imaging test in a much smaller group of women with abnormal findings on first-stage testing,’ she writes.