NEW YORK (Reuters Health), Dec 26 - Annual screening by transvaginal ultrasound and CA125 measurement does not reliably detect early-stage ovarian cancer, according to a report in the December issue of BJOG: An International Journal of Obstetrics and Gynecology.
"We and other groups confirm that the current method of ovarian screening, which is a combination of ultrasound scans and serum markers, is ineffective," Dr. Emma R. Woodward from Birmingham Women's Hospital, UK, told Reuters Health. "Therefore, for women at high risk of developing ovarian cancer, the only real option at present to prevent ovarian cancer death is to have the ovaries removed as a preventive measure."
In a retrospective study, Dr. Woodward and colleagues assessed the effectiveness of ovarian cancer screening with transvaginal ultrasound (TVU) and CA125 in 341 asymptomatic women with a family history of ovarian cancer.
Out of 1084 surveillance TVU, 929 (85.7%) were normal and 155 (14.3%) were abnormal, the authors report. Only 18 (2.1%) of 875 surveillance CA125 measures were abnormal.
Fifty-seven women (16.7%) underwent prophylactic ovariectomy, the report indicates, and 30 of the remaining women had exploratory surgery following abnormal surveillance TVU or CA125.
Four ovarian cancer cases occurred in the cohort. Only one was detected at surgery for abnormal screening results and it was classified FIGO stage III/IV, the researchers note. In the other three cases, the women presented symptomatically between screenings.
Based on these findings, TVU was only 33.3% sensitive and CA125 was only 50% sensitive for detecting ovarian cancer in high-risk women. The combination of TVU and CA125 was 50% sensitive and 82.8% specific for detecting ovarian cancer.
"By entering such a screening program, healthy women may have exploratory surgery because of false-positive findings, thereby putting themselves at risk of potential surgical complications," Dr. Woodward pointed out. "Furthermore, the few women who do develop ovarian cancer are unlikely to be diagnosed at an early stage when the disease is curable."
She concluded: "For those who are not at high risk, ovarian cancer screening should not be offered unless it is within a clinical trial aimed at developing new methods for ovarian screening."
By Will Boggs, MD
Last Updated: 2007-12-26 9:03:04 -0400 (Reuters Health)
BJOG 2007;114:1500-1509.
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