Results From Four Rounds of Ovarian Cancer Screening in a Randomized Trial

Abstract

Objective-To test whether annual screening with transvaginal ultrasound and CA-125 reduces ovarian cancer mortality.Methods-Data from the first four annual screens, denoted T0-T3, are reported. A CA-125 value at or above 35 U/ml or an abnormality on transvaginal ultrasound was considered a positive screen. Diagnostic follow-up of positive screens was performed at the discretion of participants' physicians. Diagnostic procedures and cancers were tracked and verified through medical records.Results-Among 34,261 screening arm women without prior oophorectomy, compliance with screening ranged from 83.1% (T0) to 77.6% (T3). Screen positivity rates declined slightly with transvaginal ultrasound, from 4.6 at T0 to 2.9-3.4 at T1-T3; CA-125 positivity rates (range 1.4-1.8%) showed no time trend. Eighty-nine invasive ovarian or peritoneal cancers were diagnosed; 60 were screen detected. The positive predictive value (PPV) and cancer yield per 10,000 women screened on the combination of tests were similar across screening rounds (range 1.0-1.3% for PPV and 4.7-6.2 for yield); however, the biopsy (surgery) rate among screen positives decreased from 34% at T0 to 15-20% at T1-T3. The overall ratio of surgeries to screen detected cancers was 19.5:1. Seventy-two percent of screen detected cases were late stage (III/IV).Conclusions-Through four screening rounds, the ratio of surgeries to screen detected cancers was high, and most cases were late stage. However, the effect of screening on mortality is as of yet unknown.

Plasma concentrations of the vitamin E-binding protein afamin are associated with overall and progression-free survival and platinum sensitivity in serous ovarian cancer—a study by the OVCAD consortium

“…In 2009, data from the randomized UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), assigning over 100,000 low-risk postmenopausal women to multimodal or ultrasound screening strategy arms, reported an approximately 50% detection rate of early-stage OC. In contrast, 80% of OC detected through commonly used screening methods in the Prostate, Lung, Colorectal and Ovarian (PLCO) trial were late-stage FIGO III and IV [5,6].…”

CA125 and HE4: Measurement Tools for Ovarian Cancer

“…HE4 and CA125 have their respective advantages and shortcomings. CA125 lacks specificity in diagnosing pelvic masses, particularly in differentiating benign diseases such as endometriosis in premenopausal women from ovarian cancer [10]. Other studies have demonstrated that HE4 levels can correspond with the age of healthy females; thus, HE4 lacks sensitivity in the differential diagnosis of women who are menopausal [11,12,13].…”

Fluorescence analysis of urine and its potential for ovarian cancer screening

“…Diagnosis in the early stages could lead to decreased mortality through early curative therapy [3]. At present there are no screening strategies with proven efficacy for the early detection of ovarian cancer, although several screening studies have been completed or are in progress [4,5,6,7].…”