Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high‐risk and population risk women is ineffective

Abstract

Objective To assess the efficacy of annual CA125 and transvaginal ultrasound (TVU) scan as surveillance for ovarian cancer.Design Retrospective audit.Setting NHS Trust.Population Three hundred and forty-one asymptomatic women enrolled for ovarian cancer screening: 179 were in a high-risk group (>10% lifetime risk of developing ovarian cancer), 77 in a moderate risk group (4-10% lifetime risk of developing ovarian cancer) and 71 in a near population risk group (<4% lifetime risk).Methods Retrospective audit of case records, laboratory CA125 results, radiology reports, histology records and local cancer registry data.Main outcome measures Ovarian cancers occurring in study population. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU, and CA125 as a screening tool for ovarian cancer.Results Four ovarian cancers and one endometrial cancer occurred. One ovarian cancer was detected at surveillance, three occurred in women who presented symptomatically between screenings. Thirty women underwent exploratory surgery because of abnormal findings at surveillance. Two women had cancer (PPV = 6.7%); one had ovarian cancer and the other endometrial cancer. Twenty-eight women (93.3%) had no malignancy. Sensitivity, specificity, PPV and NPV for TVU in the whole cohort were 33.3, 85.8, 0.6 and 99.8%, respectively. For high-risk individuals, the figures for TVU were 33.3, 84.5, 1.1 and 99.6, respectively. Combining both modalities for the whole cohort, the sensitivity, specificity, PPV and NPV were 66.7, 82.9, 1.5 and 99.8% and 50.0, 82.8, 1.3 and 99.7%, respectively, for the high-risk group alone.Conclusions Ovarian screening by annual TVU and CA125 is inefficient at detecting early-stage ovarian cancers.

Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk for hereditary breast ovarian cancer: A controlled observational study

“…The rationale behind ovarian cancer screening studies is that screening could detect ovarian cancer at an earlier stage and that treatment at these stages would result in higher cure rates and improved survival (90 To the current date, no studies have been able to demonstrate a reduction in ovarian cancer mortality by ovarian cancer screening, neither in the general population nor in high-risk subpopulations (92)(93)(94).…”

Short-term surgical outcome and safety of risk reducing salpingo-oophorectomy in BRCA1/2 mutation carriers

“…Until recently, ovarian cancer screening by annual transvaginal ultrasonography and evaluation of serum CA125 was considered effective for early stage diagnosis. However, in several (retrospective) series it has been shown ineffective [2][3][4][5][6][7]. The only effective and currently available strategy is a risk reducing salpingo-oophorectomy (RRSO).…”

Screening for Ovarian Cancer in Women

“…There is a very limited benefit, of screening even in high-risk women with BRCA1 and BRCA2 mutation carriers (Hermsen, Olivier et al 2007;Woodward, Sleightholme et al 2007). In addition, annual gynecological screening is unlikely to reduce mortality in women with BRCA1 and BRCA2 mutation carriers (Hogg and Friedlander 2004;Hermsen, Olivier et al 2007).…”