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Ultrasonographic screening increased detection of epithelial ovarian cancer
van Nagell JR Jr. Obstet Gynecol. 2011:118:1212-1221.
Annual ultrasonographic screening of asymptomatic women attained increased detection of early-stage ovarian cancer cases and an increase in 5-year disease-specific survival rate for women with ovarian cancer, according to a study published in Obstetrics & Gynecology.
From January 1987 to June 2011, 37,293 women were enrolled in the University of Kentucky Ovarian Cancer Screening Trial. Eligibility included asymptomatic women aged 50 years or older and asymptomatic women aged 25 years or older with a documented family history of ovarian cancer in at least one primary or secondary relative.
Before entry, study participants completed questionnaires that sought information about medical history, surgical history, menopausal status, hormonal use and family history of cancer. Women with a personal history of ovarian cancer or identified ovarian tumor were excluded from the study.
Study participants received annual transvaginal ultrasound screenings. Women with a normal screening were asked to return in 12 months, and women with an abnormal screen underwent follow-up ultrasonograms 4 to 6 weeks later. Women with persistent abnormal findings had a serum CA-125 determination; study participants with persistent solid or complex ovarian masses accompanied by high CA-125 levels were recommended to undergo surgery. Participants with ultrasound-detected ovarian cancer then were compared with unscreened women with ovarian cancer diagnoses categorized through tumor registries.
At the close of the study, positive family history of ovarian cancer was documented in 8,309 participants (22%), with 523 (1.4%) undergoing surgery based on persistent ovarian masses in imaging. The percentage of women with invasive stage I or II epithelial tumors was 70% among women with screen-detected tumors and 27% among women with registry-identified tumors. The 5-year survival rate for all participants with invasive epithelial ovarian cancer detected by screening was 74.8% ± 6.6%, compared with 53.7% ± 2.3% for unscreened women with ovarian cancer who received identical surgical and chemotherapeutic protocols (P<.001).
“The importance of early detection in ovarian cancer is evident in that more than two-thirds of asymptomatic women with ovarian cancer detected by screening in the present trial had localized disease at the time of detection, and their 5-year survival rate was nearly 90%,” researchers wrote. “In the absence of early detection, most women will continue to present with advanced-stage disease for which the cost of treatment is high and the cure rate is low.”
Disclosure: The researchers report no relevant financial disclosures.
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While an interesting analysis, particularly considering the long term follow-up of a large population, these results must be viewed in the contest of a landmark phase 3 randomized trial reported earlier this year which falied to demostrate any value associated with the current generation of ovarian cancer screening strategies. In addition, in this large national study, not only was ovarian cancer specific survival not improved, but potentially serious morbidity was documented resulting from unnecessary surgery in the screened population. For the present, ovarian cancer screening must remain an investigative strategy and cannot be considered a component of routine medical care.
Maurie Markman, MD
HemOnc
Today Editorial Board member
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