Recommendation: Routine Screening/Ovarian Ca

Recommendation

The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer.

D Recommendation

The USPSTF found fair evidence that screening with serum CA-125 level or transvaginal ultrasound can detect ovarian cancer at an earlier stage than it can be detected in the absence of screening;however, the USPSTF found fair evidence that earlier detection would likely have a small effect, at best, on mortality from ovarian cancer.

Because of the low prevalence of ovarian cancer and the invasive nature of diagnostic testing after a positive screening test, there is fair evidence that screening could likely lead to important harms. The USPSTF concluded that the potential harms outweigh the potential benefits.

Clinical Considerations

There is no existing evidence that any screening test, including CA-125, ultrasound, or pelvic examination, reduces mortality from ovarian cancer. Furthermore, existing evidence that screening can detect early-stage ovarian cancer is insufficient to indicate that this earlier diagnosis will reduce mortality.

Because there is a low incidence of ovarian cancer in the general population (age-adjusted incidence of 17 per 100, 000 women), screening for ovarian cancer is likely to have a relatively low yield.

The great majority of women with a positive screening test will not have ovarian cancer (ie, they will have a false-positive result). In women at average risk, the positive predictive value of an abnormal screening test is, at best, approximately 2%(ie, 98% of women with positive test results will not have ovarian cancer).

The positive predictive value of an initially positive screening test would be more favorable for women at higher risk.

For example, the lifetime probability of ovarian cancer increases from about 1.6% in a 35-year-old woman without a family history of ovarian cancer to about 5% if she has one relative and 7%if she has two relatives with ovarian cancer.

If ongoing clinical trials show that screening has a beneficial effect on mortality rates, then women at higher risk are likely to experience the greatest benefit.



Thanks to MEDSCAPE, and

Screening for Ovarian Cancer: Recommendation Statement

Ned Calonge, MD, MPH

Ann Fam Med 2(3):260-262, 2004. 2004 Annals of Family Medicine, Inc.

Appendix B. U.S. Preventive Services Task Force Strength of Overall Evidence

The USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor):

Good Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.

Fair Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes.

Poor Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.

Acknowledgements

Members of the U.S. Preventive Services Task Force* are Ned Calonge, MD, MPH, Chair, USPSTF (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, Colo); Janet D. Allan, PhD, RN, CS, Vice-chair, USPSTF (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, Md); Alfred O. Berg, MD, MPH (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, Wash);Paul S. Frame, MD (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, MD, MBA (Deputy Director, PanAmerican Health Organization, Washington, DC); Leon Gordis, MD, DrPH (Professor, Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md); Kimberly D. Gregory, MD, MPH (Director, Women's Health Research and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, Calif); Russell Harris, MD, MPH (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, MD, MPH (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, MD, MPH(Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Love-land-Cherry, PhD, RN (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, Mich); Virginia A. Moyer, MD, MPH (Professor, Department of Pediatrics, University of Texas at Houston, Houston, Tex); Judith K. Ockene, PhD (Professor of Medicine and Chief Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Mass); Diana B. Petitti, MD, MPH (Director, Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif); Albert L. Siu, MD, MSPH (Professor and Chairman, Brookdale Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY); Steven M. Teutsch, MD, MPH (Executive Director, Outcomes Research and Management, Merck & Company, Inc, West Point, Pa); and Barbara P. Yawn, MD, MSc (Director of Research, Olmstead Research Center, Rochester, Minn).

*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.


Ovarian Ca Screening Studied  Many False Pos/Many Findings

National Institute of Health, 11/05


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