Update: Screening for Ovarian Cancer

(February 2018 – the following is presented for informational and educational purposes only. See the Concluding Statement and Footnote 7.)

According to USPSTF, Screening for ovarian cancer is not recommended for women who (i) do not have symptoms; and (ii) do not have a known high genetic risk for developing ovarian cancer.

Background

“The United States Preventative Services Task Force (USPSTF) is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.”1 These recommendations are intended to provide guidance regarding preventative care [service] of patients by physicians and other health-care providers. “It [the Task Force] bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in the assessment.”2

The USPSTF has recently updated its Recommendation for ovarian cancer screening. It considered the question of when, and for which patients, doctors and other health care providers should screen for ovarian cancer. First-line screening can be by either or both trans-vaginal ultrasound and/or a blood test for a tumor marker referred to as “CA-125.” Neither of these screening methods is conclusive and both have been shown to result in “...high rates of false-positive findings.’3 A positive finding is usually followed by surgery to confirm a diagnosis of ovarian cancer. If a positive finding is actually false and surgery is performed, the result is unnecessary harm to the woman.

The Updated Recommendation

USPSTF’s updated recommendation is as follows:

“Screening for Ovarian Cancer: Screening is Not Recommended for Asymptomatic Women without high genetic risk for ovarian cancer.”4

USPSTF states that the Recommendation (of no screening) also applies to women who have a family history of ovarian cancer. It also cautions that the Recommendation (of no screening) does not apply to women who have tested positive for a known genetic marker – such as BRCA1 and BRCA 2 – evidencing a higher than normal risk of developing ovarian cancer.

The Conclusions (expressed and implied) – In Simple Terms

So, by both its expressed recommendation and implication, USPSTF concludes that ovarian cancer screening:

• is not recommended for women who (i) do not have symptoms; and (ii) do not have a known high genetic risk for developing ovarian cancer.
• is not recommended for women who (i) do not have symptoms; and (ii) do not have a known high genetic risk for developing ovarian cancer –even if they have a family history of ovarian cancer.

[Symptoms are described as “...vague and can include abdominal pain or pressure, feeling bloated, or feeling the size of the abdomen increase.”5]

[“High genetic risk” can be identified by a genetic test such as the BRCA 1 and BRCA 2 testing.]

• by implication, is recommended for women for have symptoms.
• by implication, is recommended for women who have tested positive for a known genetic ovarian cancer marker such as the BRCA 1 or BRCA 2 genetic mutation.

“The USPSTF concludes with moderate certainty that the potential harms of screening for ovarian cancer outweigh the potential benefits.”6

Concluding Statement

As always, if you have questions concerning ovarian cancer screening or any other matter affecting your health, medical care or treatment, you should discuss it with your doctor.7

Sources

1 https://www.uspreventiveservicestaskforce.org/
2 Journal of the American Medical Association February 13, 2018, Volume 319, Number 6, at page 588.
3 Id. At page 624.
4 Id.
5 Id.
6 Id.
7 All of this information is intended to be used for educational and informational purposes only. Such information is not intended to, and does not, constitute medical advice. Contact your physician with any questions regarding your medical health, treatment and care.