The case for early detection of ovarian cancer remains as compelling as it is challenging. Early-stage disease is usually curable, but the 22 000 diagnoses that will be made in the United States this year will mostly be late-stage cancer, for which the prognosis is poor. Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging. A positive test result can be definitively evaluated only through abdominal surgery, a procedure with its own risks. Any screening approach therefore needs to avoid undue burden on unaffected women. For a rare disease (annual incidence rate of 0.0004 in postmenopausal women), this means that a screening protocol must achieve extremely high levels of accuracy, particularly for women without cancer. And finally, we need evidence that screening in fact improves survival.
Drescher CW, Anderson GL. The Yet Unrealized Promise of Ovarian Cancer Screening. JAMA Oncol. 2018;4(4):456–457. doi:10.1001/jamaoncol.2018.0028
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