No abstract

Objective-To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer.Design-The serum CA 125 concentration of each subject was determined and those with a concentration : 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire.Setting-General practice, occupational health departments, ovarian cancer screening clinic.Subjects-22 000 women volunteers who were postmenopausal and aged over 45 years.Main outcome measures-Apparent sensitivity, specificity, positive predictive value, years of cancer detected.Results-41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 14 years.Conclusions-This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion ofcases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.

No abstract

Ovarian cancer is often diagnosed at an advanced stage and is associated with poor survival. Screening aims at detection of early stage disease with a view of improving overall survival. Incidence of ovarian cancer is about 1-2% in the low-risk and 10-40% in the high-risk population. Transvaginal ultrasound (TVS) and serum CA125 levels have been used for early detection. Annual screening with TVS and serum CA125 levels (using a cutoff value) has not demonstrated detection of ovarian cancer at an early stage. Multimodal screening (MMS) using sequential CA125 levels (with interpretation of risk using Risk of Ovarian Cancer Algorithm-ROCA) and ultrasound as the second-line test have been shown to have improved sensitivity when compared to annual ultrasound in the detection of ovarian cancer. However, no impact on survival has been demonstrated, and therefore, screening cannot be recommended in the general or high-risk population. There is evidence now to suggest that high-grade serous cancers originate from the fallopian tube where precursor lesions have been identified. Newer screening strategies are likely to shift the focus to detecting these precursor lesions with novel techniques such as exfoliative cytology, circulating tumour DNA and use of microbubbles in ultrasound imaging.