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Article
February 8, 1995

Ovarian CancerScreening, Treatment, and Follow-up

Author Affiliations

Panel and Conference Chairperson, Chairman, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Professor, Obstetrics and Gynecology, Albert Einstein College of Medicine, New Hyde Park, NY Jennie L. Batson, MD, Obstetrician and Gynecologist, Everett, Wash; Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing; Assistant Professor, Department of Biostatistics, University of Michigan, Ann Arbor; Gynecologic Oncology Clinical Nurse Specialist, Division of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY; Professor of Radiology, Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo; Professor of Medicine, Division of Medical Oncology, Milton S. Hershey Medical Center, Hershey, Pa; Medical Oncologist, Associates in Oncology and Hematology, Rockville, Md; Gynecologic Oncologist, Bethesda, Md; Associate Professor, Division of Biostatistics, Department of Epidemiology and Public Health, Yale University, New Haven, Conn; Director (Volunteer), Professional and Legal Affairs, Candlelighters Childhood Cancer Foundation, Bethesda, Md; Associate Professor, Chief, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock; Assistant Professor of Medicine, Division of Hematology and Oncology, Department of Medicine, UCLA School of Medicine, Los Angeles, Calif; Associate Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Virginia, Richmond; "Studies of the Pathogenesis and Prognosis of Previously Untreated, Epithelial Type Ovarian Cancer"; "Quality of Life in the Patient With Progressive Ovarian Cancer"; "The Role of Prophylactic Oophorectomy in Cancer Prevention"; "Clinical and Laboratory Directions" Sandra E. Brooks, MD, "Preoperative Evaluation of Patients With Suspected Ovarian Cancer"; "Management of the Symptomatic Patient: Chemotherapy"; "Controversial Issues in the Management of Early Epithelial Ovarian Cancer: Conservative Surgery and Role of Adjuvant Therapy" and "Options for Primary Chemotherapy: In Europe"; "Second-Look Laparotomy in Ovarian Cancer"; "Management of the Adnexal Mass"; "Management of Early Ovarian Cancer: Germ Cell and Sex Cord-Stromal Tumors"; "Principles of Primary Surgery" Ian Jacobs, MD, MRCOG, "Screening Modalities: CA-125/Genetic Markers"; "Screening Modalities: The Current Status of Ultrasound and Color Doppler Imaging in Screening for Ovarian Cancer"; "Screening"; "Follow-up of the Asymptomatic Patient"; "Options for Primary Chemotherapy: Taxanes"; "Research Directions in Epithelial Ovarian Cancer"; "Management of the Symptomatic Patient: Surgery"; "Second-Look Surgery in the Management of Advanced Epithelial Ovarian Cancer"; "Primary Chemotherapy for Advanced Ovarian Carcinoma"; "The Role of Radiation Therapy in Early Ovarian Cancer"; "Management of Epithelial Ovarian Tumors of Low Malignant Potential"; "Current Status of Screening for Ovarian Cancer"; "Epidemiology of Ovarian Cancer"; "Management of Early Ovarian Epithelial Cancer"; Head, Surgery Section, Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Rockville, Md; Senior Science Writer, Office of Cancer Communications, National Cancer Institute, National Institutes of Health, Bethesda, Md; Program Analyst, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Head, Developmental Chemotherapy Section, Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Rockville, Md; Director, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Professor and Deputy Chairman, Department of Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Tex; Special Assistant to the Director, Office of the Director, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Bethesda, Md; Director of Communications, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Director, Gynecologic Oncology, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Md; Chief, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Associate Director, Early Detection and Community Oncology Program, Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Rockville, Md; Director, Cleveland Clinic Cancer Center, Chairman, Department of Hematology and Medical Oncology, Cleveland (Ohio) Clinic Foundation; Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Rockville, Md; Senior Investigator, Developmental Chemotherapy Section, Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Rockville, Md; Program Director, Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Rockville, Md; Chief, Planning, Evaluation, and Analysis Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md; Chairman, The Gynecologic Oncology Group, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC; Senior Investigator, Head, Genitourinary Cancer Section, Medicine Branch, Clinical Oncology Program, Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Bethesda, Md; Chairman, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Professor, Obstetrics and Gynecology, Albert Einstein College of Medicine, New Hyde Park, NY; Deputy Director, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md

JAMA. 1995;273(6):491-497. doi:10.1001/jama.1995.03520300065039
Abstract

Objective.  —To provide physicians with a current consensus on screening, prevention, diagnosis, and treatment of ovarian cancer.

Participants.  —A nonfederal, nonadvocate, 14-member consensus panel representing the fields of gynecologic, medical, and radiation oncology, obstetrics/ gynecology, and biostatistics; 25 experts in obstetrics/gynecology and gynecologic, medical, and radiation oncology who presented data to the consensus panel; and a conference audience of approximately 500.

Evidence.  —The literature was searched through MEDLINE, and an extensive bibliography of references was produced for the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given priority over clinical anecdotal experience.

Consensus.  —The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.

Consensus Statement.  —The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. The panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.

Conclusions.  —There is no evidence available yet that the current screening modalities of CA-125 and transvaginal ultrasonography can be effectively used for widespread screening to reduce mortality from ovarian cancer nor that their use will result in decreased rather than increased morbidity and mortality. Women with stage IA grade 1 and stage IB grade 1 ovarian cancer do not require postoperative adjuvant therapy. Many remaining stage I patients do require chemotherapy. Subsets of stage I must be fully defined and ideal treatment determined. Women with stages II, III, and IV epithelial ovarian cancer (other than low malignant potential tumors) should receive postoperative chemotherapy.(JAMA. 1995;273:491-497)

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