In a new statement, the US Preventive Services Task Force (USPSTF) is recommending against ovarian cancer screening for women who have no symptoms and no hereditary cancer syndromes. The findings, based on an analysis that included 3 recent studies, reaffirms the USPSTF policy released in 2012.
Published in JAMA, the statement cites adequate evidence of at least moderate harms from screening for ovarian cancer and the possibility that it may lead to unnecessary surgery in women who do not have cancer. USPSTF found mortality benefits to be lacking, concluding with moderate certainty that the harms of screening outweigh the benefit and that the net balance of the benefit and harms of screening is negative.
USPSTF assessed evidence on use of screening with transvaginal ultrasound (TVUS), testing for CA-125, or a combination of both. The goal of the review was to update USPSTF’s 2012 recommendation on ovarian cancer screening. Three good-quality studies of the effect of annual screening in asymptomatic women not known to be at high risk for ovarian cancer were identified.
More than 200,000 postmenopausal women aged 50 to 74 years who were not known to be at high risk for ovarian cancer participated in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). They were randomized to screening with CA-125 serum testing, with triage and follow-up determined by a risk of ovarian cancer algorithm (ROCA), or to yearly TVUS. At median follow-up of 11 years, ovarian cancer mortality was not significantly different among the control group and the two intervention groups nor was there a significant difference in mortality risk in the TVUS and CA-125 ROCA groups. The smaller pilot trial for UKCTOCS, which looked at screening versus no screening, also showed no significant difference in cancer mortality. USPSTF also assessed the US PLCO trial, in which more than 68,000 women were randomized to annual screening (CA-125 plus TVUS for the first 4 rounds of screening then 2 rounds of CA-125 testing only) versus usual care. As with the UK trials, no difference in ovarian cancer screening was found between the two groups.
USPSTF’s review of evidence on harms of screening found the following false-positive rates: 11.9% for first-round screening with TVUS and 9.0% for first-round screening with CA-125 ROCA in UKCTOS; 4.2% across 3 screening rounds in the UK pilot trial; and 9.6% across all 6 screening rounds for TVUS and CA-125 in the US PLCO trial. Rates of surgery to investigate positive screening results in women who ultimately did not have ovarian cancer were 0.2% in the UK pilot CA-125 group, 0.97% in the UKCTOCS CA-125 ROCA group, 3.25% in the UKCTOCS TVUS group, and 3.17% in the PLCO CA-125 plus TVUS group. Up to 15% of these women had major surgical complications.