USPSTF Rates Ovarian Cancer Screening a D for Asymptomatic, Low-Risk Women
The USPSTF found inadequate evidence on the psychological harms of screening for ovarian cancer.
The US Preventive Services Task Force (USPSTF) has issued an updated recommendation statement for ovarian cancer screening, which was published in JAMA.
According to the task force, screening for ovarian cancer is not recommended in asymptomatic women (D recommendation). This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.
The USPSTF found adequate evidence that screening with transvaginal ultrasound, testing for the serum tumor marker cancer antigen 125 (CA-125), or a combination of both does not reduce ovarian cancer mortality. The USPSTF found adequate evidence that screening for ovarian cancer can result in important harms, including many false-positive results, which can lead to unnecessary surgical interventions in women who do not have cancer.
Depending on the type of screening test used, the magnitude of harm ranges from moderate to substantial and reflects the risk for unnecessary diagnostic surgery. The USPSTF found inadequate evidence on the psychological harms of screening for ovarian cancer. Therefore, the USPSTF concludes that there is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits.
In a separate recommendation statement, the USPSTF recommends that women with a family history indicating they are at risk for a deleterious gene mutation (BRCA1 or BRCA2) be referred for genetic counseling and, if indicated, genetic testing. The task force also concluded that the current evidence was insufficient to assess the balance of benefits and harms of screening with pelvic examination to detect a range of gynecologic conditions in asymptomatic, nonpregnant women.
“Ovarian cancer mortality has remained largely unchanged over the last 5 decades,” concluded authors Charles W. Drescher, MD, and Garnet L. Anderson, PhD, from the Fred Hutchinson Cancer Research Center in Seattle. “Early detection may yet prove to be effective, but the mortality reduction is likely to be modest. For now, the USPSTF has provided sound clinical and public health recommendations against screening for average-risk, asymptomatic women. 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. In the meantime, development of better tools for risk assessment, prevention, and early detection remain a priority.”
US Preventive Services Task Force. Screening for ovarian cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(6). doi:10.1001/jama.2017.21926
Drescher CW, Anderson GL. The yet unrealized promise of ovarian cancer screening. JAMA Oncol. 13 Feb 2018. doi:10.1001/jamaoncol.2018.0028