The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer

Nagell, J.R. van; DePriest, Paul D.; Reedy, Mark B.; Gallion, Holly H.; Ueland, F.; Pavlik, Edward J.; Kryscio, Richard J.

doi:10.1006/gyno.2000.5816

Cited by 317 publications

(81 citation statements)

References 14 publications

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“…18 A possible survival benefit was also observed in another study involving 15 000 women where the 5-year survival of patients with screen-detected ovarian cancer was 83.6 ± 10.8%. 12 However, the lack of a control group in this study raises the possibility of a 'healthy volunteer' bias.…”

Section: Screening Strategiesmentioning

confidence: 83%

“…10 Improvements in the specificity of TVS can be achieved by the use of a morphology index or through the use of colour Doppler but usually at the cost of some reduction in sensitivity. 11,12 Tumour markers CA125, the most widely investigated ovarian tumour marker, is a high molecular weight glycoprotein that is detected in the serum. Using a cut-off threshold level of 30-35 IU/l, approximately 90% of all advanced ovarian cancers and 50% of cases with disease confined to the ovaries will have a level exceeding this threshold.…”

Section: Ultrasonographymentioning

confidence: 99%

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Screening for ovarian cancer: progress and challenges

Elmasry¹

2006

j fam plann reprod health care

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Section: Screening Strategiesmentioning

confidence: 83%

Section: Ultrasonographymentioning

confidence: 99%

Screening for ovarian cancer: progress and challenges

Elmasry¹

2006

j fam plann reprod health care

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“…Interestingly, however, sensitivity for detecting stage I ovarian cancer with TVS may not exceed 90%, particularly when screening prevalent disease. Three large studies that utilized TVS have been completed that have involved more than 70,000 women in the UK, United States, and Japan (20)(21)(22) . Specificity is at the margin of that required to achieve a positive predictive value of 10%.…”

Section: Ultrasonographymentioning

confidence: 99%

New tumor markers: CA125 and beyond

BAST,

BADGWELL,

et al. 2005

Int J Gynecol Cancer

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A variety of biomarkers have been developed to monitor growth of ovarian cancer and to detect disease at an early interval. CA125 (MUC16) has provided a useful serum tumor marker for monitoring response to chemotherapy, detecting disease recurrence, distinguishing malignant from benign pelvic masses, and potentially improving clinical trial design. A rapid fall in CA125 during chemotherapy predicts a favorable prognosis and could be used to redistribute patients on multiarmed randomized clinical trials. Several studies now document that CA125 can serve as a surrogate marker for response in phase II trials. Serial measurement of CA125 might also provide a useful marker for monitoring stabilization of disease with cytostatic targeted therapeutic agents. The greatest potential for serum markers may be in detecting ovarian cancer at an early stage. A rising CA125 can be used to trigger transvaginal sonography (TVS) in a small fraction of patients. An algorithm has been developed that calculates risk of ovarian cancer based on serial CA125 values and refers patients at highest risk for TVS. Use of the algorithm is currently being evaluated in a trial with 200,000 women in the UK that will test critically the ability of a two-stage screening strategy to improve survival in ovarian cancer. Whatever the outcome, as 20% of ovarian cancers have little or no expression of CA125, additional serum markers will be required to detect all patients in an initial phase of screening. More than 30 serum markers have been evaluated alone and in combination with CA125 by different investigators. Some of the most promising include: HE4, mesothelin, M-CSF, osteopontin, kallikrein(s), and soluble EGF receptor. Two proteomic approaches have been used: one examines the pattern of peaks on mass spectroscopy and the other uses proteomic analysis to identify a limited number of critical markers that can be assayed by more conventional methods. Both approaches are promising and require further development. Several groups are placing markers on multiplex platforms to permit simultaneous assay of multiple markers with very small volumes of serum. Mathematical techniques are being developed to analyze combinations of marker levels to improve sensitivity and specificity. In the future, serum markers should improve the sensitivity of detecting recurrent disease as well as facilitate earlier detection of ovarian cancer.

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“…The limited sensitivity and specificity of both transvaginal ultrasound and serum CA125 levels are of concern, given previous evidence of the adverse psychological impact of false positive ovarian cancer screening results (20,21) . Also, although some studies suggest screening improves the rate of early detection (22,23) , a systematic review of 25 prospective screening studies found no evidence that screening is effective in reducing deaths from ovarian cancer (24) .…”

Section: Limitations Of Screening and Prophylactic Measuresmentioning

confidence: 99%

A decision aid for women at increased risk for ovarian cancer

Tiller

Meiser

Reeson

et al. 2003

Int J Gynecol Cancer

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This paper reviews changes that have occurred within and without the medical profession that have fostered an increasing demand for decision aids as adjuncts to practitioners' counseling to prepare patients for decision making. In the absence of data on the efficacy of ovarian cancer screening and prophylactic strategies, decisions about optimal care are difficult for both women and their doctors. Because surveillance and preventive options are an area of great uncertainty, a decision aid has been developed specifically aimed at facilitating decisions involving ovarian cancer risk management options. This was achieved by reviewing and integrating the available literature on models of medical decision making, patient preferences for information and involvement in decision making, the utility of decision aids, and management options for ovarian cancer risk. Findings indicate that patients wish to be informed participants in the decision-making process and that decision aids are an acceptable and effective method of providing quality information in a format that facilitates an inclusive model of shared decision making. A decision aid designed for women at increased risk of ovarian cancer that facilitates informed decision making may be a valuable addition to patient support. A randomized controlled trial of this type of educational material will provide timely and much needed evidence on its acceptability and efficacy.

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The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer

Cited by 317 publications

References 14 publications

Screening for ovarian cancer: progress and challenges

Screening for ovarian cancer: progress and challenges

New tumor markers: CA125 and beyond

A decision aid for women at increased risk for ovarian cancer

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