Risks outweigh benefits for ovarian cancer screening

The U.S. Preventive Services Task Force has updated its recommendations on the effectiveness of routine screening for ovarian cancer, and continues to advise against routine screening for women without symptoms or a genetic predisposition to ovarian cancer. The recommendations were published Monday in the Annals of Internal Medicine.

Ovarian cancer is the fifth leading cause of cancer death among women, and has the highest death rate of all gynecological cancers. More than 22,000 women in the United States will be diagnosed with ovarian cancer in 2012, according to the American Cancer Society. While ovarian cancer can strike all women, the majority of women diagnosed with ovarian cancer are over age 40, with the largest number of cases found in women over age 60, according to the Centers for Disease Control and Prevention .

Available screening methods include transvaginal ultrasonography and the CA-125 test which identifies blood proteins that can signal ovarian cancer. But other harmless or less harmful conditions can also increase CA-125 levels, including pregnancy, normal menstruation, uterine fibroids, cirrhosis and endometrial cancer.

When the USPSTF analyzed the most recent data on screening for ovarian cancer, they weighed the risk benefits and harms of screening. Harms of screening were greater, due to the high number of false positive tests produced by the CA-125. And the study notes “the majority of women with a positive screening test will have a false positive result.”

According to the background information in the guidelines, “one-third of women with a false-positive result had an oophorectomy,” meaning a third of women with a false positive test needlessly lost their ovaries. And more than 20% of women who had surgical procedures had complications.

It's important to note that the guidelines recommend screening for certain women, including those with symptoms of ovarian cancer, which can include abdominal pain, bloating, bowel changes, abnormal bleeding and back pain. And screening is advised for certain women with known genetic mutations that predispose them to ovarian cancer, including the BRCA1 and BRCA2 mutations, Lynch syndrome, or a family history of ovarian cancer. Women should speak with their health care provider to determine whether they should be screened for ovarian cancer.