Ovarian cancer screening still offers little benefit, task force says

The U.S. Preventive Services Task Force in a JAMA article published Tuesdayrecommended against ovarian cancer screening for asymptomatic women, concluding the harms of screening outweigh the benefits. 

This recommendation reiterates the task force's 2012 guidance. The task force periodically revisits its recommendations when new evidence is available to ensure its conclusions are "still right," said Dr. Michael Barry, a task force member and director of the informed medical decisions program at Massachusetts General Hospital in Boston. 

There is widespread consensus in the medical community that ovarian cancer screening is ineffective for the general population, the task force noted in the JAMA article. The American College of Obstetricians and Gynecologists and the American Cancer Society also don't recommend screening for asymptomatic women. 

The two common screening methods for ovarian cancer are transvaginal ultrasound and a blood test called CA-125.

The Preventive Services Task Force reviewed three recent studies, including a large 2016 clinical trial in the United Kingdom, and concluded the screening methods caused a high incidence of false-positives and led to unnecessary surgery for women. Women typically need to have their ovaries removed in order to test them for cancer, Barry said. 

Additionally, the studies found that screenings didn't reduce ovarian cancer mortality rates. 

Ovarian cancer is the fifth most common cause of cancer death for women in the U.S. Although its incidence is relatively low, the mortality rate is high because women often aren't diagnosed early enough. For 60% of women diagnosed with ovarian cancer, the cancer has already spread to other parts of the body. 

"Ovarian cancer is hard to detect, particularly early stages where the outcomes might be better," Barry said. 

The task force recommends that clinicians and patients rely on family history and genetic testing to determine women who are at high-risk for ovarian cancer. Two gene mutations—BRCA1 and BRCA2—have been identified as indicators that a woman will likely get the cancer at some point. 

Dr. Elizabeth Swisher, a professor in gynecologic oncology at UW Medicine, agreed with the task force's recommendations. She said as gene testing because increasingly less expensive, it's an effective way to detect the cancer in women. 

If a woman age 40 and older is found to have one of the gene mutations, their ovaries are typically removed because that is when risk for the cancer increases. 

Barry said there is work going on to improve screening methods. "We hope there will be better blood tests over time and better imaging tests to better screen for cancer," he said.