Ovarian cancer screening—ultrasound; impact on ovarian cancer mortality

Abstract

Although ovarian cancer (OC) is the most lethal of all female malignancies, debate still exists concerning the benefits and harms of the screening programs and their impact on long-term survival and mortality from the disease. The most widely tested screening strategies have focused on transvaginal ultrasound (TVU) and on algorithms that measure serum levels or interval changes of cancer antigen-125 (CA-125) either individually or in combination. Transvaginal ultrasound can identify size and morphology changes of the ovary that may signal a developing malignancy; yet, it is still accused of having a low specificity. There is preliminary evidence that screening can improve survival, but the impact of screening on mortality from OC is still unclear and warrants further validation. In spite of having many published prospective studies, up to-date, none have been able to demonstrate conclusively a reduction in mortality from OC both in the screened general or high-risk population. Data from the US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial has not shown survival or mortality benefits in the general population. Most prospective trials have reported a decrease in stage at detection (with the exception of the PLCO trial), thereby allowing treatment to be initiated when the disease is most curable. Research is in progress to develop new diagnostic tests and novel biomarkers, which when used in combination can increase the accuracy and outcomes of screening. In this review article, we will discuss the debate provoked on OC screening programs and the impact of using ultrasound on the reduction of OC-related mortality.

NF-κB Signaling in Ovarian Cancer

“…Ovarian cancer (OC) is the most lethal gynecologic malignancy [1]. The low survival rate of approximately 40% owes to the intra- and inter-tumor heterogeneity, diagnosis at an advanced stage and high rate of recurrence and chemoresistance that classifies this disease [2]. There is increasing evidence that the high rate of disease recurrence after chemotherapy is due to residual populations of cancer stem cells (CSCs) that escaped therapy and re-establish the disease, leading to progression [3].…”

Progesterone reduces cell survival in primary cultures of endometrioid ovarian cancer

“…Prevention of known risk factors and early detection have made possible to reduce breast and cervical cancer as a cause of death among women, although this is not the case with ovarian cancer diagnosis which is usually established at advanced stages [1–3]. Transvaginal ultrasound and CA125 blood determination, although useful for early detection, are not applicable to the whole population [4–6]. In industrial countries, ovarian cancer is the most lethal of gynecologal cancer and it is estimated that 185,000 women around the world will die from this disease in 2018 [7].…”

Ovarian Cancer - Current Status of Blood Biomarker and Imaging Screening Strategies

“…A cut off value of 35 U/ml is considered significant and tumour size of 3 mm is considered sufficient to generate a positive biomarker screen as shown in several mathematical biomarker models. [18][19][20] However, the UK collaborative trial of ovarian cancer screening (UKCTOCS) uses the ROCA approach which is based on every woman having her own individual baseline value and incorporates serial change in biomarker levels over time into the cancer screening strategy. CA-125 blood level changes equal or greater than 30 U/ml above baseline were identified as significant.…”