What is the screening recommendation for ovarian cancer?

1.

Elsevier ClinicalKey Clinical Overview

Screening and Prevention Routine screening is not recommended for asymptomatic women with an average risk of developing ovarian cancer Recommendation applies to all methods: bimanual palpation of ovaries, imaging, and biomarker levels Available evidence suggests that screening for ovarian cancer in asymptomatic women not known to be at high risk for ovarian cancer does not reduce ovarian cancer mortality Offer genetic testing for ovarian cancer susceptibility genes in the following: Patients with a first- or second-degree relative diagnosed with epithelial ovarian cancer at any age Patients who have probability of BRCA1/BRCA2 pathogenic variant of greater than 5% based on probability models Some experts recommend monitoring women at high risk of developing ovarian cancer with serum CA 125 level and transvaginal ultrasonography starting at age 30 to 35 years; however, this screening strategy is of uncertain benefit

2.

Armstrong, Deborah K. (2024). In Goldman-Cecil Medicine (pp. 1375). DOI: 10.1016/B978-0-323-93038-3.00184-2

Screening for ovarian cancer is not recommended in women who do not have symptoms. Neither serum CA-125 levels, alone or in combination with other markers, nor transvaginal ultrasound benefits the general population, and these tests are of limited value even in high-risk women. Few strategies are available to prevent ovarian cancer. The use of oral contraceptive agents (Chapter 220) for 5 years or longer reduces the incidence of ovarian cancer by about 50%. For high-risk women, such as women withBRCA1orBRCA2mutations, prophylactic removal of the fallopian tubes and ovaries is recommended beginning at age 35 years and when childbearing is complete. Such surgery is the most effective approach to reduce the risk of ovarian cancer but is associated with complications of early menopause (Chapter 222). Given the role of the fallopian tube in ovarian carcinogenesis, the opportunistic removal of the fallopian tubes is increasingly recommended for primary prevention of epithelial ovarian malignancies.This approach entails removal of the fallopian tubes in average-risk women undergoing pelvic surgery for another indication and allows preservation of the ovary without interruption of ovarian hormonal function. Common procedures that could potentially include opportunistic salpingectomy include hysterectomy for benign indications and in place of tubal ligation for women who desire sterilization.

3.

Grossman DC, Curry SJ, Owens DK, et al. Jama. 2018;319(6):588-594. doi:10.1001/jama.2017.21926.

Publish date: February 2, 2018.

Importance: With approximately 14 000 deaths per year, ovarian cancer is the fifth most common cause of cancer death among US women and the leading cause of death from gynecologic cancer. More than 95% of ovarian cancer deaths occur among women 45 years and older. Objective: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for ovarian cancer. Evidence Review: The USPSTF reviewed the evidence on the benefits and harms of screening for ovarian cancer in asymptomatic women not known to be at high risk for ovarian cancer (ie, high risk includes women with certain hereditary cancer syndromes that increase their risk for ovarian cancer). Outcomes of interest included ovarian cancer mortality, quality of life, false-positive rate, surgery and surgical complication rates, and psychological effects of screening. Findings: The USPSTF found adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality. The USPSTF found adequate evidence that the harms from screening for ovarian cancer are at least moderate and may be substantial in some cases, and include unnecessary surgery for women who do not have cancer. Given the lack of mortality benefit of screening, and the moderate to substantial harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concludes with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative. Conclusions and Recommendation: The USPSTF recommends against screening for ovarian cancer in asymptomatic women. (D recommendation) This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.