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October 12, 2011

Ovarian Cancer Screening and Mortality—Reply

Author Affiliations

Author Affiliations: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland (Dr Black); University of Utah Health Sciences Center, Salt Lake City (Dr Buys); and Division of Cancer Prevention, National Cancer Institute (Dr Berg) (bergc@mail.nih.gov).

JAMA. 2011;306(14):1544-1545. doi:10.1001/jama.2011.1462

In Reply: Given that ovarian cancer is hypothesized to have a short latency, it is plausible, as Dr Menon and colleagues suggest, that the benefit of screening may be limited to the few years after screening. However, at 7 years from randomization (2 years after screening), the absolute number of ovarian cancer deaths was greater in the intervention than usual care groups (54 vs 50), providing a rate ratio for ovarian cancer mortality of 1.08 (95% CI, 0.74-1.59). This higher mortality in the intervention group was consistent throughout follow-up. Further, a decrease in the absolute number of late-stage cancers is thought to be necessary but not sufficient for a mortality benefit to be realized; we observed no such stage shift in cancers diagnosed in the intervention group during the screening phase (95 and 73 stage III and IV cancers in the intervention and control groups, respectively).