GU cancer

Thumbs down to ovarian cancer screening

The US Preventive Services Task Force (USPSTF) has recommended against population screening for ovarian cancer in asymptomatic women not known to be at high risk due to inherited gene mutations.

The recommendation, consistent with those from other organisations, is based on the lack of mortality benefit with screening, the lack of suitable tests and the risk of potential harms following screening including unnecessary surgery.

“Given that most cases of ovarian cancer are diagnosed at later stages, when associated mortality is high, further research is needed to identify new screening strategies that could accurately detect ovarian cancer early, at a point when outcomes could be improved,” theUSPSTF statement suggested.

According to the updated USPSTF guideline, there was a need for more specific imaging and serological tests that minimised the potential for false positives and further unnecessary investigations.

An editorial in JAMA said early detection of ovarian cancer would likely involve a 2-stage strategy including an inexpensive blood test followed by imaging in women with abnormal test results.

“Although transvaginal ultrasound is currently used as the second stage test, novel imaging technologies that detect much smaller volumes of abnormal cells might ultimately prove to make ovarian cancer screening more effective.”

An editorial in JAMA Oncology emphasised that the USPSTF recommendation did not apply to women with genetic mutations that increase ovarian cancer risk.

In those women, ovarian cancer screening was ‘a reasonable, if temporary alternative’ to risk-reduction salpingo-oophorectomy, it said.

Another editorial in JAMA Internal Medicine said ‘we should not give up entirely on ovarian cancer screening’ given, for example, new knowledge about high-grade serous ovarian cancers that originate in the fallopian tubes.

“We can hope that the screening community will adapt to the discovery by the pathologists of these emergent fallopian lesions by designing new imaging techniques and molecular tests, but these are not yet available.”

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