Are there screening tests for ovarian cancer?

Stephen K. Montoya, MD
OBGYN (Obstetrics & Gynecology)
There is no clear screening test for ovarian cancer, says Stephen Montoya, MD, an OB/GYN at Sunrise Hospital. In this video he explains how genetic screening can help identify your risk for the disease.

Cancer antigen 125, or CA-125, may be elevated in women with ovarian cancer. However, CA-125 may not be significantly elevated in women with early stage disease and thus is not a reliable screening test. Your doctor can also use ultrasound to assess the size and shape of your ovaries, although this is not a reliable screening test either. In women with known BRCA1 or BRCA2 mutations or other risk factors, the doctor may choose to do an ultrasound or measure blood levels of CA-125. In most healthy women, however, these tests have limited benefit.

Sharyn N. Lewin, MD
OBGYN (Obstetrics & Gynecology)
Unlike with cervical cancer, there isn't an effective way at the present time to screen women for ovarian cancer. While most women's lifetime risk for having ovarian cancer is less than 2 percent, women with one of the three high-risk genetic mutations (BRCA1, BRCA2 and HNPCC) have between 10 and 60 percent life-time risk. This risk increases with age.

Since 90% percent of ovarian cancers are not genetic, it is important that women know the warning signs and discuss these with their physicians. Persistent symptoms like abdominal pain, urinary urgency and bloating would warrant evaluation, especially if digestive and urinary conditions are ruled out.

If there is a suspicion for ovarian cancer or if a woman is high-risk for developing ovarian cancer, I will recommend a pelvic and rectal exam, in addition to a transvaginal ultrasound (TVUS) and a blood sample for a CA-125 level. If symptoms are present, she will need a CT scan.

In many large studies, screening for ovarian cancer has not been shown to detect or catch cancers early enough. Therefore, if a women is high-risk for ovarian cancer due to an abnormality in one of the genes listed above, she may need her ovaries removed after childbearing is complete as screening is not effective.

The principal tests that might be used to screen symptomless women for ovarian cancer are pelvic examination, measurement of serum tumor markers, and ultrasound imaging.

Pelvic examination: Experts do not know how good pelvic examinations are at detecting ovarian cancer. Although they can occasionally find ovarian cancers, because of the location of the ovary, palpation (feeling with the hand) often fails to find small, early stage tumors. Therefore, the ovarian cancers that pelvic examinations do find usually are in the advanced stage and present a poor outlook for survival.

Measurement of serum tumor markers: "Tumor markers" are substances in the blood that often are elevated when a person has cancer. When women are known or suspected of having ovarian cancer, these markers have been able to indicate early cancers pretty well. However, this may not be the case for women who have no symptoms. Experts do not know if the levels increase early enough to be spotted by screening tests. More reliable data is needed to decide whether these elevations really are accurate in detecting early stage ovarian cancer in women with no symptoms. Another consideration is the potential for error: tumor markers can be elevated in perfectly normal women, and in the presence of conditions that are not cancerous at all -- for example, benign masses such as fibroids (noncancerous growths in the uterus) and endometriosis (growth of misplaced uterine tissue outside the uterus) -- plus some nongynecologic cancers as well (pancreas, stomach, colon, and breast).

Ultrasound imaging: This diagnostic tool uses the reflection of sound waves in the body to create a picture. Unfortunately, routine ultrasound testing of women who have no symptoms detects very few ovarian cancers. It does, however, produce many mistakenly positive results that often require potentially risky follow-up procedures, such as laparotomy (surgical incision of the abdomen) or laparoscopy (visual inspection of the abdomen).

Diljeet K. Singh, MD
Gynecologic Oncology

For women at average risk for ovarian cancer, there are currently not good, standard screening tools available. Watch as gynecologic oncologist Diljeet Singh, MD, discusses the symptoms to be aware of that could help detect ovarian cancer early.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.