Women who are asymptomatic and are not at a high hereditary risk for ovarian cancer should not be screened for the disease, according to released today by the U.S. Preventive Services Task Force (USPSTF).
The organization made the same recommendation in 2012. A USPSTF spokesperson said pelvic exams can still be useful for women with symptoms.
The research team looked at whether pelvic exams were useful to screen for a range of gynecologic conditions.
Task force members said they found evidence that ovarian screenings, such as pelvic exams, blood tests, and ultrasounds, resulted in no benefits and instead caused harm.
“As a result, we are recommending against screening women without signs or symptoms for ovarian cancer,” the spokesperson said.
Ovarian cancer is the fifth most common cause of cancer deaths in women in the United States. About 14,000 women die from it each year in the U.S., the task force report stated.
Who to screen
The news comes after British researchers recommended last month that all women over the age of 30 be tested for gene mutations that can cause breast and ovarian cancer.
Dr. Stephanie V. Blank, a gynecologic oncology professor at the Icahn School of Medicine at Mount Sinai in New York, agreed with the recommendations.
Women who believe they are at a risk should talk with their doctors. Together, they can decide if genetic testing or screening is appropriate, Blank said.
What happens if you’re not “at risk” but still want testing conducted? Blank said it still may be possible.
“A woman who really wants ovarian cancer screening and does not have an indication for it or any symptoms would have to convince her doctor to order the tests. If they are ordered, sometimes they will be covered [by insurance] and sometimes they will not,” Blank told Dr.China.
Dr. Ernst Lengyel, chairman of the Department of Obstetrics and Gynecology at The University of Chicago, agreed that most doctors will do testing if the patient wants it, regardless of their risk.
“The key point is that by doing this, you will not necessarily discover ovarian cancer earlier,” he noted. “However, there will be findings that require further workup that will be emotionally stressful for the patient and require additional procedures.”
In an accompanying editorial, Dr. Charles W. Drescher and Garnet L. Anderson, PhD, researchers at the Fred Hutchinson Cancer Research Center in Seattle, said that a positive test result can be definitively evaluated only through abdominal surgery.
That procedure comes with its own risks, they said.
Drescher and Anderson noted that the guidelines were based on data from three randomized clinical trials.
The USPSTF recommendations are consistent with recently published combined American College of Obstetricians and Gynecologists guidance, which found there was no early detection strategy for ovarian cancer that could reduce mortality from the disease.
Challenges of ovarian cancer screening
Ovarian cancer screening is typically done first by pelvic exam.
A CA-125 blood test and transvaginal ultrasound can confirm the disease.
Screening via the latter two methods does not reduce mortality from ovarian cancer, the USPSTF stated.
They do not recommend screening via any of those three methods in women who are asymptomatic and not at risk.
There is evidence that screening can result in false-positive results, which can lead to unneeded surgeries, the report said.
Using the blood test to detect ovarian cancer presents problems. It can spot other conditions that are not ovarian cancer, so getting a positive result does not mean a woman has ovarian cancer. Not all women with ovarian cancer have high CA-125 levels, the reports.
Dr. Karen H. Lu, a gynecologic oncology and reproductive medicine professor from the University of Texas MD Anderson Cancer Center, noted that doctors must make decisions based on available tests as to whether to conduct a surgery.
If so, the surgery is typically a laparoscopic procedure with the potential to remove abnormalities.
If there was a better “second stage” test that was more specific or accurate than transvaginal ultrasound, it would cut down on unnecessary surgeries, she noted.
Lu also said that one of the most important advancements in lowering ovarian cancer deaths is being able to pinpoint women at high risk using BRCA1 and BRCA2 genetic testing.
Currently, the study sponsored by Lu’s institution aims to make genetic testing for cancer more accessible to all people.
The notion behind the program would be to allow people to complete saliva-based genetic testing from the comfort of their homes.
Lengyel said his laboratory is working on a more comprehensive blood test. He said not having a better screening method is frustrating.
“We need more science to find a test that does work better,” he said. “I am optimistic in the next few years we will find a test to screen for ovarian cancer or at least differentiate between benign and malignant adnexal masses,” he said.
Women, stay informed
Current methods are not good enough to warrant for women at normal risks, which is why it’s “critically important” to identify women at high, inherited risk of ovarian cancer through genetic testing, said Dr. Elizabeth Swisher, co-leader of the Stand Up To Cancer Ovarian Cancer Research Fund Alliance and National Ovarian Cancer Coalition Ovarian Cancer Dream Team.
Blank agreed, adding: “Because screening for ovarian cancer is not effective, it is extremely important that women be aware of the symptoms of ovarian cancer and advocate for themselves.”
Symptoms of ovarian cancer include bloating, trouble eating, urinary frequency, and pelvic or abdominal pain.
Women who experience those should demand testing, Blank added.