Stirling, Diane, Evans, D. Gareth, Pichert, Gabriella, Shenton, Andrew, Kirk, Elaine N., Rimmer, Sylvia, Steel, C. Michael, Lawson, Sheila, Busby-Earle, R. M. Camille, Walker, Jane, Lalloo, Fiona I., Eccles, Diana M., Lucassen, Anneke M. and Porteous, Mary E. (2005) Screening for familial ovarian cancer: failure of current protocols to detect ovarian cancer at an early stage according to The International Federation of Gynecology and Obstetrics System. Journal of Clinical Oncology, 23 (24), 5588-5596. (doi:10.1200/JCO.2005.05.097).
Abstract
Purpose:
To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk.
Patients and Methods:
A cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease.
Results:
Thirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer.
Conclusion:
Annual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.
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