Does screening for ovarian cancer have a mortality benefit?

January 01, 0001

Does screening for ovarian cancer have a mortality benefit?

Ovarian cancer is a feared disease, in part for its frequent lack of symptoms until it reaches an advanced state. The marker CA-125 and ultrasound have been used in screening, but their benefit is unclear. These US and Canadian researchers examined screening for ovarian cancer and its effect on mortality as part of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. This large trial included women 55 to 74 years of age who were randomized to either annual screening with CA-125 for 6 years and ultrasound for 4 years (n = 39,105) or no screening (n = 39,111). Enrollees were followed for up to 12 years. Results of the screening were given to the enrollees and their health care providers, who managed any abnormal results.

The researchers found: "Ovarian cancer was diagnosed in 212 women (5.7 per 10 000 person-years) in the intervention group and 176 (4.7 per 10 000 person-years) in the usual care group (rate ratio {RR}, 1.21). There were 118 deaths caused by ovarian cancer (3.1 per 10,000 person-years) in the intervention group and 100 deaths (2.6 per 10,000 person-years) in the usual care group (mortality RR, 1.18). Of 3285 women with false-positive results, 1080 underwent surgical follow-up, of whom, 163 women experienced at least 1 serious complication (15%). There were 2924 deaths due to other causes (excluding ovarian, colorectal, and lung cancer) (76.6 per 10,000 person-years) in the intervention group and 2914 deaths (76.2 per 10,000 person-years) in the usual care group (RR, 1.01)."

The researchers concluded: "Among women in the general US population, simultaneous screening with CA-125 and transvaginal ultrasound compared with usual care did not reduce ovarian cancer mortality. Diagnostic evaluation following a false-positive screening test result was associated with complications."

Screening for ovarian cancer with CA-125 or transvaginal ultrasound does not improve mortality.

For the full abstract, click here.

JAMA 305(22):2295-2303, 8 June 2011 © 2011 American Medical Association
Effect of Screening on Ovarian Cancer Mortality. Saundra S. Buys, Edward Partridge, Amanda Black, et al.

Category: X. Female Genital System, Breast. Keywords: ovarian cancer, CA-125, ultrasound, screening, mortality, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 24 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.