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JAMA Patient Page
February 13, 2018

Screening for Ovarian Cancer

JAMA. 2018;319(6):624. doi:10.1001/jama.2017.22136

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for ovarian cancer in asymptomatic women.

What Is Ovarian Cancer?

The ovaries are part of the reproductive system in women, responsible for making and storing eggs. Ovarian cancer occurs most often in women aged 45 years or older. In many cases, there are few or no symptoms until the cancer has progressed into later stages. Symptoms are vague and can include abdominal pain or pressure, feeling bloated, or feeling the size of the abdomen increase. Treatment generally includes surgery and sometimes chemotherapy.

What Tests Are Used to Screen for Ovarian Cancer?

Screening for ovarian cancer can be done by using an ultrasound to look for any abnormalities in the ovaries. Another option is performing a blood test for a tumor marker called CA-125 that is associated with ovarian cancer. The use of routine pelvic examinations to screen for general gynecologic conditions including ovarian cancer is discussed in a separate USPSTF recommendation.

What Is the Patient Population Under Consideration for Screening for Ovarian Cancer?

This USPSTF recommendation applies to women who do not have any signs or symptoms of ovarian cancer. This includes women who have a family history of ovarian cancer. However, the recommendation does not apply to women who have a known genetic mutation, such as BRCA1 or BRCA2, that puts them at higher risk of ovarian cancer.

What Are the Potential Benefits and Harms of Screening for Ovarian Cancer?

The potential benefit of screening for ovarian cancer is finding the cancer earlier, given that it generally does not cause symptoms in early stages. However, 3 randomized trials have found that screening with ultrasound, CA-125 testing, or both did not decrease the overall death rate due to ovarian cancer. Furthermore, current screening techniques of both ultrasound and CA-125 testing result in high rates of false-positive findings. These false positives lead to the potential harm of unnecessary treatment. Because diagnosis of suspected cancer is generally confirmed by surgery to remove one or both ovaries (rather than by biopsy), the potential harm of unnecessary surgical removal of the ovaries in women who do not have cancer is substantial.

How Strong Is the Recommendation for Screening for Ovarian Cancer?

The USPSTF concludes with moderate certainty that the potential harms of screening for ovarian cancer outweigh the potential benefits.

Bottom Line: Current Recommendation Screening for Ovarian Cancer

The USPSTF does not recommend screening for ovarian cancer in asymptomatic women (“D” recommendation).

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Article Information

Source: US Preventive Services Task Force. Screening for ovarian cancer: US Preventive Services Task Force recommendation statement [published February 13, 2018]. JAMA. doi:10.1001/jama.2017.21926

Topic: Preventive Medicine