Ovarian Cancer Screening Not Recommended for Most Women: USPSTF

02/16/18

By Megan Brooks

NEW YORK (Reuters Health) - In its final recommendation released today, the U.S. Preventive Services Task Force (USPSTF) advises against ovarian cancer screening in asymptomatic women not known to be at high risk, concluding that the potential harms of screening outweigh the benefits.

The latest recommendation on ovarian cancer screening is in line with the task force’s draft recommendation issued in July 2017 and consistent with the 2012 final recommendation.

The new report and evidence review were published online February 13 in JAMA, along with several editorials in the JAMA family of journals.

Each year, roughly 14,000 women die of ovarian cancer, making it the fifth most common cause of cancer death among U.S. women and the leading cause of death from gynecologic cancer. The vast majority of these deaths occur in women age 45 or older.

Ovarian cancer is an “important health condition,” and one of the challenges is that symptoms often don't develop until late in the disease, so it's only natural to think about screening to detect disease earlier, task force member Dr. Michael Barry of Massachusetts General Hospital, Boston, said in a JAMA podcast.

The USPSTF reviewed clinical trial evidence of the benefits and harms of ovarian screening in asymptomatic women without certain hereditary cancer syndromes that increase their risk for ovarian cancer. Interventions included transvaginal ultrasound (TVS), cancer antigen 125 (CA-125) or a combination of the two methods, typically compared with usual care or no screening. “Outcomes of interest” included death from ovarian cancer, quality of life, false-positive rate, surgery and surgical complications, and psychological effects of screening.

There is “adequate evidence” that screening does not reduce deaths from ovarian cancer mortality and that the harms from screening are “at least moderate and may be substantial in some cases, and include unnecessary surgery for women who do not have cancer,” the task force says.

Therefore, they conclude with “moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” according to the report.

“No professional group has recommended in favor of ovarian cancer screening, so our recommendation really agrees with recommendations from other groups like the American Cancer Society, American College of Obstetricians and Gynecologists, the American College of Radiology and others,” said Dr. Barry.

This recommendation does not apply to women with genetic mutations that substantially increase ovarian cancer risk. Women with germline mutations are candidates for risk-reduction salpingo-oophorectomy (RRSO), the task force notes.

“For now, the USPSTF has provided sound clinical and public health recommendations against screening for average-risk, asymptomatic women,” conclude the authors of an editorial in JAMA Oncology. “In the meantime, development of better tools for risk assessment, prevention, and early detection remain a priority,” write Drs. Charles Drescher and Garnet Anderson from Seattle's Fred Hutchinson Cancer Research Center.

In an editorial in JAMA Internal Medicine, Dr. Steven Narod from Women's College Hospital in Toronto, Canada, says, “We should not give up entirely on ovarian cancer screening. Screening for ovarian cancer is not ready for prime time, but there are reasons why we should continue the quest.”

In a JAMA editorial, Dr. Karen Lu from University of Texas MD Anderson Cancer Center in Houston focuses on lessons learned during the past two decades about the prospect for better early-detection strategies: “First, it seems likely that effective, early detection of ovarian cancer will involve a 2-stage strategy that includes a first-stage, inexpensive test (for example, a blood test) followed by an imaging test in a much smaller group of women with abnormal findings on first-stage testing. Although TVUS is currently used as the second-stage test, novel imaging technologies that detect much smaller volumes of abnormal cells might ultimately prove to make ovarian cancer screening more effective.”

Developing and validating new biomarkers also will be important, Dr. Lu says. “Broadening the strategy to include accurate risk models and genetic testing, novel prevention options, and effective early detection may help reduce the incidence and high mortality associated with ovarian cancer,” she concludes.

SOURCES: http://bit.ly/2ECIkH3, http://bit.ly/2G9u5Xj, http://bit.ly/2nYxDVP, http://bit.ly/2BtcavV and http://bit.ly/2HbW5el

JAMA, JAMA Intern Med, JAMA Oncol 2018.

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