Most women should not get screened for ovarian cancer unless they are in a high-risk category, suggests a new review.
The United States Preventive Services Task Force (USPSTF) examined a wide range of previous studies in an effort to establish if screening for ovarian cancer does reduce mortality risk for women who are not at hereditary risk of the condition.
The results of their efforts were published in the journal JAMA, and the first author of the new paper is Jillian T. Henderson, Ph.D., of the Center for Health Research at the Kaiser Permanente Northwest in Portland, OR.
As Henderson and her team point out, ovarian cancer is the fifth leading cause of cancer mortality among U.S. women. In fact, a recent estimate projected a total of 14,080 deaths from ovarian cancer in 2017.
Over 60 percent of ovarian cancer cases are diagnosed after the cancer has spread, the authors write. However, screening trials did not prove to affect mortality rates in the past.
In fact, studies have attested to the harms of such screenings, including false-positive results that led to surgery and ensuing complications.
So, the USPSTF set out to “systematically review evidence on benefits and harms of ovarian cancer screening among average-risk women.” Their findings update their 2012 guidelines.
Screening may do more harm than good
Henderson and her colleagues examined “a total of 1,381 titles and abstracts and 74 articles” from medical databases such as Medline and Cochrane.
The studies considered were published over a period of 14 years, between 2003 and 2017, and most of them were randomized clinical trials of screening versus no screening in asymptomatic women aged 45 and above. This category is seen as “average-risk.”
Among the outcomes measured were ovarian cancer-related mortality, false-positives, surgery and surgical complications, and psychological effects of screening and their results.
After carrying out their extensive analysis, the team concluded that “ovarian cancer mortality did not significantly differ between screened women and those with no screening or in usual care.”
However, “Screening harms included surgery (with major surgical complications) in women found to not have cancer,” the authors add.
Given these new findings, the USPSTF conclude with “moderate certainty” that there are more disadvantages and potential harms to ovarian cancer screening than there are benefits.
Therefore, they do not advise average-risk women to undergo such a procedure.
Women should advocate for themselves
Dr. Stephanie V. Blank — a professor of gynecologic oncology in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai in New York City, NY — comments on the significance of these recommendations.
She says, “I agree that women who are not at increased genetic risk for ovarian cancer should not be offered ovarian cancer screening because we do not have an effective screening test.”
“In the general population,” Dr. Blank continues, “ovarian [cancer] is a relatively rare disease and the specificity of our current tests is not acceptable — false positives in ovarian cancer screening can result in unindicated surgeries.”
But she warns, “A woman who believes she is at increased genetic risk for cancer should discuss this with her doctor and together they can decide whether genetic testing and/or screening is appropriate.”
“A woman,” Dr. Blank continues, “who really wants ovarian cancer screening and does not have […] any symptoms would have to convince her doctor to order the tests. […]”
“[However, i]f a woman has symptoms of ovarian cancer (e.g., bloating, trouble eating, pelvic or abdominal pain, urinary frequency) she should demand this testing!”
Dr. Stephanie V. Blank
“Because screening for ovarian cancer is not effective it is extremely important that women be aware of the symptoms of ovarian cancer and advocate for themselves,” she concludes.