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Ovarian Cancer Screening Update

by Wellness Letter  

Women should not be routinely screened for ovarian cancer, according to updated guidelines from the U.S. Preventive Services Task Force, which re­­iterate recommendations from 2004 and 2012. Despite its low incidence compared to other cancers, ovarian cancer kills about 14,000 women a year in the U.S., mostly those ages 45 and older. Screening tests include transvaginal ultrasound and the CA-125 blood test.

As reported in the Journal of the American Medical Association in February 2018, the task force reviewed the evidence from four clinical trials involving nearly 300,000 women and concluded with “moderate certainty” that the harms of screening outweigh the benefits in asymptomatic women at average risk for the disease, since screening did not significantly reduce ovarian cancer deaths, while false-positives led to un­­necessary surgery that can have major complications. In fact, most women with positive results on these screening tests do not have ovarian cancer. The task force—which didn’t take cost of screening into consideration—gave the evidence about routine screening a “D” grade (meaning there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits”).

The updated recommendation does not apply, however, to women at elevated risk for ovarian (or breast) cancer due to family history, who should discuss genetic testing and screening with their doctor. And women with new or unusual symptoms that persist for more than two weeks—such as bloating, abdominal pain or pressure, urgent or frequent urination, or difficulty eating or feeling full quickly—should see their doctor promptly, since these may be early signs of the disease.

The task force’s recommendation against screening in average-risk, asymptomatic women is in line with that of the American Academy of Family Physicians. Other organizations do not recommend routine screening, including the American College of Obstetricians and Gynecologists, the American Cancer Society, and the American College of Radiology. All experts agree that better screening methods—such as more sensitive blood and imaging tests—are needed to catch the cancer at its earliest stages, when it’s more treatable.

This article first appeared in the UC Berkeley Wellness Letter.

Also see Mammography: Is Every 2 Years Enough?