SUMMARY:

The USPSTF has posted its final recommendation regarding ovarian cancer screening on February 13, 2018. The Task Force is standing by previous guidance and considers the evidence sufficient to recommend against routine screening with transvaginal ultrasound and/or CA-125 for ovarian cancer.

KEY POINTS:

Reference Population

• Asymptomatic women
• This recommendation does NOT refer to women who are at increased risk for ovarian cancer, for example personal or family risk of the following:
  • Hereditary Breast Ovarian Syndrome (BRCA1 / BRCA2)
  • Lynch Syndrome
  • Li-Fraumeni Syndrome
  • Peutz-Jeghers Syndrome
  • Family History of Ovarian Cancer

Benefits

• Transvaginal ultrasound and/or CA-125 measurements do not reduce deaths due to ovarian cancer

Harms

• Excessive false positives in asymptomatic women lead to unnecessary surgical interventions
  • False positive rates range from 4.2% to 44.2%
• Magnitude of harm rated from moderate to substantial depending on the risk of the unnecessary surgery
  • Percentage of women who went for unnecessary surgeries range from 0.2% to 3.2%
• Insufficient evidence to determine if there are psychological harms as well

Other Professional Guidelines

ACOG

• Does not recommend screening for ovarian cancer in low-risk, asymptomatic women
• Evaluation of high-risk women may include transvaginal ultrasound and CA-125 testing, in addition to physical examination

ACS

• Does not recommend screening for ovarian cancer in average-risk women

ACR

• Does not recommend screening for ovarian cancer in average-risk women

AAFP

• Recommends against screening for ovarian cancer in asymptomatic women (consistent with USPSTF)

Conclusions

• There is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits
• There is adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality
• Based on 3 large good-quality studies, there does not appear to be any benefit in ovarian cancer mortality from annual screening in asymptomatic, non-high risk women
• The USPSTF assessed studies that included CA-125
  • Whether CA-125 was used as a single cut-off measure or within the framework of an age-adujsted algorithm, there was no difference in ovarian cancer mortality
• Based on the above, the Draft Recommendation is a ‘D’ Grade
  • The USPSTF recommends against screening for ovarian cancer in asymptomatic women

Learn More – Primary Sources:

Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement

Related PcMed Topics:

Guidance Update: Professional Organizations Align on Cervical Cancer Screening