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October 10, 1986

Screening for Ovarian Cancer

Author Affiliations

University of California, San Diego School of Medicine La Jolla

JAMA. 1986;256(14):1892. doi:10.1001/jama.1986.03380140062010

To the Editor.—  In his response to the question regarding screening ultrasonography for ovarian carcinoma, Dr Ferrucci1 beautifully reviews the current state of the art and then concludes with erroneous recommendations. Certainly, ovarian carcinoma is a significant disease, accounting for 25% of all gynecologic cancers and over half the gynecologic cancer deaths.2 As Dr Ferrucci says, "the clinical benefit of early detection of ovarian cancer" has not been shown.Dr Ferrucci's list of "high-risk" patients deserves closer attention. "Difficulties in physical examination due to obesity or vaginal stenosis" and "cancerophobia" are not risk factors for ovarian cancer. Many known risk factors (nulliparity, early menopause, type A blood, pelvic irradiation, breast cancer, high-fat diet, and others)2 were omitted from the list. But this is a moot point since even in high-risk patients ultrasonography has no demonstrated benefit.Dr Ferrucci refers to the "less experienced" examiner and "difficult performance