Physicians may be ignoring ovarian cancer screening recommendations

Baldwin LM. Ann Intern Med. 2012;156:182-194.

Nearly 30% of physicians reported routinely ordering ovarian cancer screening for women at low risk for the disease, despite recommendations to the contrary, according to recent results.

Researchers in the United States conducted a cross-sectional survey of 3,200 physicians offering women’s primary care to estimate the extent to which they are adhering to recommendations against ovarian cancer screening. The researchers hypothesized that physicians are overscreening women and, therefore, exposing them to potential harms. The 12-page questionnaire used to evaluate outcomes contained a vignette about a woman’s annual examination and follow-up questions.

Participants were randomly sampled equally from the 2008 American Medical Association Physician Masterfile lists of family physicians, general internists and obstetrician-gynecologists. The response rate was 61.7%, for an analysis population of 1,088 physicians.
The primary outcome measure was reported nonadherence to screening recommendations, which the researchers defined as sometimes or almost always ordering screening transvaginal ultrasonography or CA-125, or both.

The nonadherence rate for women at low risk for ovarian cancer was 28% (95% CI, 24.5-32.9). The rate was 65.4% (95% CI, 61.1-69.4) for women at medium risk for ovarian cancer. Six percent (95% CI, 4.4-8.9) of physicians routinely ordered or offered screening to women at low risk for ovarian cancer, and 24% of physicians did so for women at medium risk (P<.001).

Thirty-three percent of respondents reported that the two screening measures were effective.
The strongest predictors of physician-reported nonadherence to recommendations were actual and physician-perceived patient risk, patient request for ovarian cancer screening, and physician belief that one of the two screening tests was effective, according to results of an adjusted analysis.

“One in [three] physicians believed that ovarian cancer screening was effective, despite evidence to the contrary,” Laura-Mae Baldwin, MD, MPH, professor of family medicine at the University of Washington, and colleagues wrote. “Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests.”

Follow HemOncToday.com on Twitter.