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USPSTF: Routine screens for ovarian cancer not recommended

Key clinical point: Harms associated with ovarian cancer screening included unnecessary surgery and surgical complications.

Major finding: In three trials including 293,038 women, ovarian cancer screening had no significant impact on mortality.

Study details: The recommendations were based on data from four trials including 293,587 women.

Disclosures: The researchers had no financial conflicts to disclose.

Source: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

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Women with known risk factors could benefit from screening

Abdominal surgery remains the only way to definitely confirm a positive result for ovarian cancer screening, and therefore any screening protocol must achieve a high level of accuracy to minimize the potential for unnecessary procedures in unaffected women, Charles W. Drescher, MD, and Garnet L. Anderson, PhD, wrote in an accompanying editorial in JAMA Oncology (2018 Feb 13. doi: 10.1001/jamaoncol.2018.0028).

“Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging,” they said. Data from three randomized trials failed to show a disease-specific mortality reduction, and the USPSTF recommendations against routine screening align with recent recommendations from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and an opinion piece from the Society of Gynecologic Oncology.

Women with germline mutations that increase their risk of ovarian cancer are not included in the recommendations and may be candidates for risk reduction salpingo-oophorectomy (RRSO), which has been shown to reduce ovarian cancer risk but is not confirmed as a preventive measure, the editorialists said.

More targeted screening could improve the likelihood of overall benefit, but the USPSTF recommendations offer “sound clinical and public health recommendations against screening for average-risk, asymptomatic women,” they emphasized. In the meantime, “Potential risks and benefits of screening with CA-125 and TVS deserve to be part of the discussion with high risk women, at least for women not considering RRSO,” they said.

Dr. Drescher and Dr. Anderson are affiliated with the Fred Hutchinson Cancer Center in Seattle. They had no financial conflicts to disclose.


 

FROM JAMA

Screening asymptomatic women for ovarian cancer does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.

The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.

The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.

The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.

Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.

The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.

The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.

The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.

The task force members had no financial conflicts to disclose.

SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.

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