Screening for Ovarian Cancer

Abstract

Ovarian cancer is often diagnosed at an advanced stage and is associated with poor survival. Screening aims at detection of early stage disease with a view of improving overall survival. Incidence of ovarian cancer is about 1-2% in the low-risk and 10-40% in the high-risk population. Transvaginal ultrasound (TVS) and serum CA125 levels have been used for early detection. Annual screening with TVS and serum CA125 levels (using a cutoff value) has not demonstrated detection of ovarian cancer at an early stage. Multimodal screening (MMS) using sequential CA125 levels (with interpretation of risk using Risk of Ovarian Cancer Algorithm-ROCA) and ultrasound as the second-line test have been shown to have improved sensitivity when compared to annual ultrasound in the detection of ovarian cancer. However, no impact on survival has been demonstrated, and therefore, screening cannot be recommended in the general or high-risk population. There is evidence now to suggest that high-grade serous cancers originate from the fallopian tube where precursor lesions have been identified. Newer screening strategies are likely to shift the focus to detecting these precursor lesions with novel techniques such as exfoliative cytology, circulating tumour DNA and use of microbubbles in ultrasound imaging.

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

“…Several studies have demonstrated no such association [39]. Moreover, a recent Australian study discovered no correlation between time of symptom onset and FIGO stage III and IV disease, and concluded that longer time to diagnosis does not affect survival in women, even with advanced stage ovarian cancer [40]. A large qualitative study noted no difference between duration of symptom onset or time to diagnosis amongst patients with early to more advanced disease.…”