USPSTF Recommends Against Screening for Ovarian Cancer in Asymptomatic Women

The US Preventive Services Task Force recommends against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome because evidence shows that screening does not reduce ovarian cancer mortality.

The US Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.

From 2010 to 2014, the age-adjusted incidence of ovarian cancer was 11.4 cases per 100,000 per year. Despite its low incidence, ovarian cancer ranks as the fifth most common cause of death for US women and the leading cause of death from gynecologic cancer.

USPSTF’s grade D recommendation, along with the rationale behind it, was published in JAMA. According to the recommendation statement, the positive predictive value of screening tests for ovarian cancer is low, and there is a high false-positive rate, resulting in most women with a positive screening test result not having ovarian cancer.

The USPSTF found adequate evidence that screening with transvaginal ultrasound, testing for the serum tumor marker cancer antigen 125, or a combination of the 2 does not reduce ovarian cancer mortality. USPSTF pointed to the UK Collaborative Trial of Ovarian Cancer Screening, the Prostate Lung Colorectal and Ovarian cancer screening trial, and the United Kingdom pilot trial, which were all consistent in showing that there was no significant reduction in cancer mortality between those receiving either of the screening methods and those not being screened.

There was also adequate evidence that screening for ovarian cancer can result in significant harms, such as a plethora of false-positive results, which can lead to unnecessary surgical interventions.

Depending on the type of screening test used, the scale of harm ranges from moderate to substantial, and reflects the risk for unnecessary diagnostic surgery, according to the statement. The statement concluded that there is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits.

However, several editorials published in the JAMA network argue that ovarian cancer screening should not be completely discarded.

An editorial in JAMA Oncology states that, “Meaningful benefit could be expected to accrue with incremental improvements in screening performance. Better risk-prediction tools could lead to more targeted screening and a likelihood of an overall benefit, even with current screening modalities.”

According to the editorial, additional biomarkers, specifically those that are not dependent on tumor burden, may yield better screening performance, potentially at an earlier stage.

In a JAMA Internal Medicine editorial, the author notes that a few things have changed since the trials assessed by USPSTF: it is now believed that high-grade serous ovarian cancers originate in the fallopian tube, and there is a false assumption that cancer stage is the best predictor of survival.