PURPOSE: To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk. PATIENTS AND METHODS: A cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease. RESULTS: Thirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer. CONCLUSION: Annual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.
PURPOSE: To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk. PATIENTS AND METHODS: A cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease. RESULTS: Thirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer. CONCLUSION: Annual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.
Authors: Phuong L Mai; Marion Piedmonte; Paul K Han; Richard P Moser; Joan L Walker; Gustavo Rodriguez; John Boggess; Thomas J Rutherford; Oliver Zivanovic; David E Cohn; J Tate Thigpen; Robert M Wenham; Michael L Friedlander; Chad A Hamilton; Jamie Bakkum-Gamez; Alexander B Olawaiye; Martee L Hensley; Mark H Greene; Helen Q Huang; Lari Wenzel Journal: Gynecol Oncol Date: 2017-02-10 Impact factor: 5.482
Authors: M Robyn Andersen; Jason Thorpe; Diana S M Buist; J David Beatty; Kate Watabayashi; Nancy Hanson; Robert Resta; Jessica Chubak; Nicole Urban Journal: Behav Med Date: 2014-11-03 Impact factor: 3.104
Authors: Carolyn Y Fang; Carol Cherry; Karthik Devarajan; Tianyu Li; John Malick; Mary B Daly Journal: Gynecol Oncol Date: 2009-01-13 Impact factor: 5.482
Authors: Mark H Greene; Marion Piedmonte; Dave Alberts; Mitchell Gail; Martee Hensley; Zoe Miner; Phuong L Mai; Jennifer Loud; Gustavo Rodriguez; Jack Basil; John Boggess; Peter E Schwartz; Joseph L Kelley; Katie E Wakeley; Lori Minasian; Stephen Skates Journal: Cancer Epidemiol Biomarkers Prev Date: 2008-03 Impact factor: 4.254