USPSTF Recommends Against Routine Ovarian Cancer Screening

New recommendations from the United States Preventative Services Task Force (USPSTF) recommend against routine screening of low- and moderate- risk patients without symptoms, according to an evidence report recently published in JAMA.

The new recommendation is based on a meta-analysis of research involving 293,587 patients. Studies included four clinical trials that measured the mortality and adverse outcomes of ovarian cancer patients against multiple ovarian cancer screening methods.

“Evidence shows that current screening methods do not prevent women from dying of ovarian cancer and that screening can lead to unnecessary surgery in women without cancer,” Michael J Barry, MD, professor of medicine at Harvard Medical School and task force member said in a news release.

The USPSTF recommendation advises against screening in asymptotic women who are not at high-risk. The recommendation noted that women with “a high-risk hereditary cancer syndrome,” — including presence of the BCRA gene mutation, should still be screened.

However, in an accompanying editorial, Charles W Drescher, MD, and Garnet L Anderson, PhD, both of the Public Health Sciences Division, Fred Hutchinson Cancer Research Center, screening can still be wasteful and harmful among high-risk patients.

“Screening is not an effective alternative to surgical prevention, so mutation-positive women should be advised of its limitations and risks, including false-positive and false-negative test results and potentially unnecessary surgery,” they wrote.

Alternatively, in an editorial in JAMA Internal Medicine, Steven A. Narod, MD, of the Women’s College Hospital Research Institute in Canada, wrote that ovarian screening could still hold some value for early detection and mortality reduction.

“Despite the careful Task Force review of the evidence for screening using current technology (CA-125 and ultrasonography), we should not give up entirely on ovarian cancer screening,” he wrote.

Dr Narod explained that recent advances in the understanding of how ovarian cancer manifests could lead to more reliable screening methods in the future.

“We can hope that the screening community will adapt to the discovery by the pathologists of these emergent fallopian lesions by designing new imaging techniques and molecular tests, but these are not yet available,” he wrote. “Screening for ovarian cancer is not ready for prime time, but there are reasons why we should continue the quest.”

—David Costill

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