About 1% of women develop ovarian cancer, but the symptoms typically do not appear until the cancer already has spread, which makes it difficult to treat. The mortality rate is higher for ovarian cancer than for any other gynecological cancer, and is the fifth-leading cause of death from cancer among women.
USPSTF in its latest recommendation, published Tuesday in JAMA, said it "found adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality" and "that the harms from screening for ovarian cancer are at least moderate and [might] be substantial in some cases, … includ[ing] unnecessary surgery for women who do not have cancer." USPSTF said, "There is at least moderate certainty that the harms of screening for ovarian cancer outweigh the benefits."
As such, USPSTF recommended against ovarian cancer screenings for asymptomatic women who are not known to have high-risk hereditary cancer syndrome—assigning such screenings a "D recommendation." Under the Affordable Care Act, insurers are required to cover preventive services that receive a "B" grade or higher from USPSTF without cost-sharing.
Chien-Wen Tseng, a USPSTF member and chair of health services and quality research at the University Of Hawaii School Of Medicine, said USPSTF "is calling for research to find better screening tests and treatments that can help reduce the number of women who die from ovarian cancer."
Michael Barry, a USPSTF member and director of the informed medical decisions program at Massachusetts General Hospital, said, "Ovarian cancer is hard to detect, particularly early stages where the outcomes might be better." He continued, "We hope there will be better blood tests over time and better imaging tests to better screen for cancer."
Researchers say better screening methods needed
Charles Drescher and Garnet Anderson, both of the Fred Hutchinson Cancer Research Institute, in an editorial published in JAMA Oncology wrote that USPSTF offered "sound clinical and public health recommendations against screening for average-risk, asymptomatic women," but noted that USPSTF's recommendations do not apply to women who have genetic mutations that raise the risk of ovarian cancer. They wrote, "Potential risks and benefits of screening with CA-125 and (transvaginal ultrasound) deserve to be part of the discussion with high-risk women, at least for women not considering (risk-reduction salpingo-oophorectomy)."
Karen Lu of the University of Texas MD Anderson Cancer Center in an editorial published in JAMA wrote that effective screening would require better strategies for early detection, which are currently unavailable. Lu wrote that early detection strategies and complementary prevention strategies must be combined to achieve a meaningful reduction in ovarian cancer mortality and morbidity. Lu wrote, "Early and microscopic cancers in prophylactic specimens from women with BRCA1 or BRCA2 genetic mutations are fallopian-tube cancers, and surgical removal of the fallopian tubes and ovaries are the foundation of prevention in these high-risk women. Broadening the strategy to include accurate risk models and genetic testing, novel prevention options, and effective early detection may help reduce the incidence and high mortality associated with ovarian cancer."
Stephanie Blank, a professor of gynecologic oncology at the Icahn School of Medicine at Mount Sinai, generally agreed with the recommendations "because we do not have an effective screening test." Blank said, "A woman who believes she is at increased genetic risk for cancer should discuss this with her doctor, and together they can decide whether genetic testing or screening is appropriate." She added, "[I]f a woman has symptoms of ovarian cancer –bloating, trouble eating, pelvic or abdominal pain, urinary frequency—she should demand this testing" (Bankhead, MedPage Today, 2/13; Castellucci, Modern Healthcare, 2/13; Preidt, HealthDay News, 2/13).
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