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Ovarian Cancer Screening & Mortality

Effect of early detecting and screening studied

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A multimodal approach to ovarian cancer screening may detect ovarian cancer significantly early to reduce mortality, according to a study of 202,638 postmenopausal women aged 50 to 74 years who were randomly allocated to multimodal screening (MMS, 25%), ultrasound screening (USS, 25%), or to no screening (50%). At median follow-up of 11.1 years, researchers found:

• Ovarian cancer was diagnosed in 0.6% of women: 0.7% in the MMS group, 0.6% in the USS group, and 0.6% in the no screening group, not reaching statistical significance.

• Mortality reduction, not reaching statistical significance, over years 0 to 14 years, was 15% with MMS and 11% with USS.

• A significant mortality reduction with MMS was noted when cases that were likely prevalent at the start of the study were excluded.

Citation: Jacobs IJ, Menon U, Ryan A, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. [Published online ahead of print December 17, 2015]. Lancet. doi: 10.1016/S0140-6736(15)01224-6.

Commentary: Ovarian cancer is the fifth leading cause of cancer death among women in the US, with 25,400 new cases and 14,300 deaths. Lifetime probability of ovarian cancer is 1.6% in a 35-year-old woman without a family history of ovarian cancer. This risk increases to 5% with 1 relative and 7% if a woman has 2 relatives with ovarian cancer. Because of this high burden of disease, and the fact that ovarian cancer is usually diagnosed at an advanced stage, it has been looked at as a potential area of screening for years, but screening has not up until this study been shown to benefit women. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial looked at over 68,000 women randomized to CA-125 and trasvaginal ultrasound vs usual care and after 12 years of follow-up did not show a reduction in ovarian cancer mortality.1 In that study, approximately 1,000 women underwent surgery for false-positive results on screening. In the Lancet study reviewed above, approximately 1% of the MMS group and 3% of the USS group had false positive surgeries. The current USPSTF recommendation is againt screening for ovarian cancer in women at average risk, a grade “D” recommendation.2 This study will certainly be added to the analysis when ovarian cancer screening is next formally evaluated. —Neil Skolnik, MD

1. Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA.2011;305(22):2295-303. doi: 10.1001/jama.2011.766.

2. U.S. Preventive Services Task Force: Ovarian Cancer: Screening at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/ovarian-cancer-screening. Accessed December 21, 2015.

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