Screening for ovarian cancer: is there still hope?

Abstract

Mainly diagnosed at advanced stage, ovarian cancer still remains the most lethal gynecological malignancy. Regarding screening and early detection, ovarian cancer poses particular challenges. To date, no screening test has been proven capable of leading to a mortality benefit. In this short review, we summarize and discuss the underlying literature on screening for ovarian cancer, focusing on average-risk, asymptomatic women as well as women at high risk. We also discuss the continuous advances and limits in liquid biopsies for early detection and screening of ovarian cancer.Keywords Fallopian tube cancer · BRCA · CA125 · Ultrasound · Liquid biopsies Although ovarian cancer is rare with a lifetime risk of 1.3% and an incidence of 6.6 per 100,000 women per year, it is the 7th most common cancer and 6th most common cause of cancer death for women globally. In Europe, there were 67,771 new cases of ovarian cancer and 44,576 deaths in women in the year 2018. The majority of cases are diagnosed at an advanced stage, after the cancer has metastasized, leading to poor survival [1,2]. The term ovarian cancer includes a heterogenous group of malignant tumors arising from different precursor cells. The group of malignant nonepithelial ovarian tumors comprises germ cell tumors, sex cords stromal ovarian tumors, small cell car-

Potential Impact of Human Cytomegalovirus Infection on Immunity to Ovarian Tumours and Cancer Progression

“…Presently, the early features of ovarian carcinogenesis remain unclear, and there is no effective early detection test or screening method to date [ 5 ]. Therefore, the identification of women with the disease is based on their clinical presentation, in combination with currently approved, albeit non-specific, tests including ultrasound and/or serum cancer antigen 125 (CA-125) and human epididymis 4 (HE4) levels, followed by histological confirmation with tissue biopsy [ 6 ].…”

Comparison of Ultrasound and Tumor Marker CA125 in Diagnosis of Adnexal Mass Malignancies

“…However, it has been reported that the level of serum CA-125 is often elevated in women with endometriosis or endometriomas. [ 6 9 ] For example, Jacobs and Menon[ 11 ] found that CA-125 serum levels exceeded 35 U/mL in approximately 10% of women with benign tumors and in a higher percentage of women with serous benign tumors than among those with cystic teratomas. Our results agree with those of others in that CA-125 serum levels were elevated more often among premenopausal women with benign tumors than among postmenopausal women with benign tumors and thus were more useful in distinguishing between benign and malignant tumors in postmenopausal patients.…”

“…The majority of cases are diagnosed at an advanced stage, after cancer has metastasized, leading to poor survival. [ 6 ] Given the difference in survival in initial and advanced stages, screening programs or finding adnexal masses at initial stages are the other ways for increasing survival. Familial history, symptoms, physical examination, imaging, especially transvaginal sonography (TVS), and tumor markers are among the methods used for assessment of adnexal masses.…”

Diagnostic Routes and Time Intervals for Ovarian Cancer in Nine International Jurisdictions; Findings From the International Cancer Benchmarking Partnership (ICBP)

“…Ovarian cancer (OC) is the eighth most common cancer in women globally and the gynaecological malignancy with the highest mortality, accounting for over 180,000 deaths per year [1]. At present, there is no effective screening for OC, and many women are diagnosed with late-stage disease, resulting in low survival rates [2,3]. International variation persists in the proportion diagnosed at late stage, and in OC survival across all stages [2].…”