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USPSTF: No Need for Routine Ovarian Ca Tests
MedPageToday, 2012Preventive Services Task Force (USPSTF), in a draft statement, reaffirmed that ovarian cancer screening for most women does more harm than good and that clinicians should discourage it.
Since 2004, when the USPSTF initially recommended against routine ovarian cancer screening, no evidence has emerged that would suggest a net benefit from testing with the usual methods -- transvaginal ultrasound scans and CA-125 antigen levels in serum.
Potential harms from screening, such as invasive procedures consequent to false-positive screening results, outweigh the potential benefits, the draft statement said.
But it also emphasized that the recommendation does not apply to women with specific risk factors for ovarian cancer, including BRCA1/2 genetic mutations or a family history of the disease.
In a review, task force members cited the lone randomized trial that evaluated mortality following ovarian cancer screening, the .
It found a nonsignificant trend toward a higher rate of ovarian cancer cases detected with screening versus the unscreened control group, but no difference in cancer stage at diagnosis or in the death rate from ovarian cancer.
On the other hand, several studies have confirmed high rates of false-positive findings with CA-125 and ultrasound screening, which frequently led to surgical procedures and clearly adverse outcomes.
In the PLCO trial, 10% of participants in the screening arm had false-positive results at some point; the investigators calculated a positive predictive value for screening of barely 1%.
Moreover, for every 100 surgical procedures conducted for false-positive screens, more than 20 had major complications.
The draft statement also mentioned an ongoing trial in Great Britain, for which preliminary results have also indicated a high false-positive rate.
There has not yet been enough follow-up to evaluate the effect of screening on ovarian cancer detection or mortality.