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Are screenings for ovarian cancer practical?

Barbara A. Goff, MD
Gynecologic Oncology

Currently screening is not recommended for average women because the harms of false positive screening outweigh the benefits. No cancer or women's organization recommend that women without a significant family history undergo screening. That is why it is very important for women and physicians to be aware of the symptoms of ovarian cancer. Currently the best way to diagnose ovarian cancer early is for patients and practitioners to have a high index of suspicion in women who present with specific symptoms. The symptoms to be concerned about include bloating, abdominal or pelvic pain, difficulty eating, feeling full quickly, and urinary urgency. As these symptoms can occur in any of us from time to time, the type symptoms that are concerning for ovarian cancer are those that occur almost every day and have persisted for more than 2-3 weeks.

Gustavo Rodriguez, MD
Gynecologic Oncology
There is a lot of controversy over ovarian cancer screenings. The problem is that as a disease, ovarian cancer has not lent itself well to a screening approach. It’s based on a number of mathematical variables. If you were to put 100,000, 60-year-olds in a football stadium, 50 or 60 of them might have ovarian cancer. If doctors have a test that has 98% accuracy, which sounds really good, you’re going to end up with 2,000 abnormal results in 100,000 women, and yet only 50 or so have ovarian cancer.

The consequence of that is, for every 40 or 50 women who are operated on, only one will actually have the disease. So that’s been the huge hurdle in ovarian cancer. 
Dr. Michael Roizen, MD
Internal Medicine
Ovarian cancer has never had the research funding that breast cancer gets, but when the screening tests for ovarian cancer -- the CA-125 blood test that looks for cancer antibodies, and transvaginal ultrasound -- were introduced, everyone was really hopeful that it would become easier to diagnose ovarian cancer in its early stages. Now, the U.S. Preventive Services Task Force (USPSTF) has declared that "there is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits."

Confused? Let us clarify: These ovarian cancer screening tests are still recommended for women at high risk (i.e., any woman who has had breast cancer; who has the BRCA-1 and BRCA-2 genes; who has a relative who has had breast cancer, colorectal cancer, or ovarian cancer; or anyone who is obese. The heaviest women have a 50% increased risk of ovarian cancer.

The USPSTF is warning against screening tests for everyone else because they result in too many false positives. In the words of the USPSTF, "screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have cancer."

The good news is many companies are working on ovarian cancer diagnostic tests that may be more reliable: blood tests that look for multiple cancer markers, not just CA-125; monoclonal antibodies that target ovarian cancer cells types; and gene- and protein-based tests.

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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.