EXECUTIVE SUMMARY

The U.S. Preventive Services Task Force has issued a draft recommendation statement on ovarian screening, finding that the potential harms of screening outweigh the benefits.

  • The draft guidance recommends that women who have no signs or symptoms should not be screened for ovarian cancer. The new guidance falls in line with the Task Force’s 2012 directive, which also recommended against screening women at an average risk for ovarian cancer.
  • Ovarian cancer is the fifth leading cause of cancer death among women in the United States. The Centers for Disease Control and Prevention reports that 21,161 women in the United States were diagnosed with ovarian cancer in 2014, and 14,195 women died from the disease.

The U.S. Preventive Services Task Force (USPSTF) has issued a draft recommendation statement on ovarian screening, finding that the potential harms of screening outweigh the benefits.1 The draft guidance recommends that women who have no signs or symptoms should not be screened for ovarian cancer. The new guidance falls in line with the USPSTF’s 2012 guidance, which also recommended against screening women at average risk.2

Ovarian cancer is the fifth leading cause of cancer death among women in the United States.3 The Centers for Disease Control and Prevention (CDC) reports that 21,161 women in the United States were diagnosed with ovarian cancer in 2014, and 14,195 women died from the disease.4 Although the disease causes more deaths than any other affecting the female reproductive system, it only accounts for 3% of all cancers in women, the CDC estimates.3

“The Task Force found that screening women without signs or symptoms for ovarian cancer does not decrease the number of deaths from the disease and may lead to unnecessary surgeries,” said Task Force member Maureen Phipps, MD, MPH, department chair and Chace-Joukowsky professor of obstetrics and gynecology and assistant dean for teaching and research on women’s health at the Warren Alpert Medical School of Brown University in Providence, RI, in a release accompanying the draft guidance. “Therefore, the Task Force recommends against screening for ovarian cancer in women who have no signs or symptoms and who are not at high risk for ovarian cancer.”

Check Accuracy of Tests

Evidence indicates that current screening tests for ovarian cancer are not very accurate, with false-positive results leading to unnecessary surgeries. Cancer antigen-125, used as a tumor marker in epithelial ovarian cancer, has a low sensitivity and specificity. It is only raised in approximately 50% of the first stage of epithelial ovarian cancers, and in 75% to 90% of patients with advanced disease.5

“The current screening tests do not do a good job identifying whether a woman does or does not have ovarian cancer,” said Task Force chair and Seattle pediatrician David Grossman, MD, MPH, in a press statement. “The Task Force hopes that in the future, better screening tests for ovarian cancer will be developed.”

What Can You Do?

Clinicians need to do all that they can to prevent ovarian cancer, says Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA.

Letting women know that combined oral contraceptives reduce this cancer risk may lessen their reluctance to use hormonal contraception, Nelson says.

The efficacy of oral contraceptives in ovarian cancer chemoprophylaxis makes them an important strategy for selected high-risk women who have not completed childbearing.6,7 (Contraceptive Technology Update reported on the research; see “Research Affirms Protective Benefit of Oral Contraceptives,” June 2017, available at http://bit.ly/2eWephY.)

A new approach in reducing the most serious epithelial ovarian cancer is to encourage salpingectomy at the time of hysterectomy, and perhaps in place of tubal interruption or occlusion, says Nelson. This practice, known as opportunistic bilateral salpingectomy, is gaining momentum as a potential strategy for preventing epithelial ovarian cancer.8 Data suggest this practice has been associated with a 40% to 65% decrease in the incidence of epithelial ovarian cancer when performed at the time of benign hysterectomy in patients at risk for the disease.8

A 2015 Committee Opinion by the American College of Obstetricians and Gynecologists notes that prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients; however, randomized, controlled trials are needed to support its impact in reducing the incidence of ovarian cancer.9 

REFERENCES

  1. U.S. Preventive Services Task Force. Draft recommendation statement. Ovarian cancer: Screening. Available at: http://bit.ly/2tbKsg7. Accessed Aug. 21, 2017.
  2. Moyer VA; U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2012;157:900-904.
  3. Centers for Disease Control and Prevention. Ovarian cancer statistics. Fact sheet. Available at: http://bit.ly/2uG7O0u. Accessed Aug. 21, 2017.
  4. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2014 Incidence and Mortality Web-based Report. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2017. Available at: https://nccd.cdc.gov/uscs/. Accessed Aug. 21, 2017.
  5. Rauh-Hain JA, Krivak TC, Del Carmen MG, Olawaiye AB. Ovarian cancer screening and early detection in the general population. Rev Obstet Gynecol 2011;4:15-21.
  6. Iversen L, Sivasubramaniam S, Lee AJ, et al. Lifetime cancer risk and combined oral contraceptives: The Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol 2017;216:580.e1-580.e9.
  7. Moorman PG, Havrilesky LJ, Gierisch JM, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: A systematic review and meta-analysis. J Clin Oncol 2013;31:4188-4198.
  8. Kho RM, Wechter ME. Operative outcomes of opportunistic bilateral salpingectomy at the time of benign hysterectomy in low-risk premenopausal women: A systematic review. J Minim Invasive Gynecol 2017;24:218-229.
  9. Committee on Gynecologic Practice. Committee opinion no. 620: Salpingectomy for ovarian cancer prevention. Obstet Gynecol 2015;125:279-281.