This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendation forward screening for ovarian cancer and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2d ed (1) In 1996, the USPSTF commended against routine screening for ovarian cancer (D recommendation). (1) Since then, the USPSTF criteria to rate the solidity of the evidence have changed. (2) Therefore, this recommendation statement has been updated and revised based onward the current USPSTF methodology and rating of the puissance of the evidence. Explanations of the existing taskforce ratings and strength of overall evidence are given in Tables 1 and 2 respectively.

The total information on which this statement is based, including evidence tables and relations is available in the brief evidence update (3) upon this topic on the USPSTF Web site (http://www.preventiveservices. ahrq.gov). The recommendation statement and brief evidence update also are available in print from the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone: 1-800-358-9295; e-mail: ahrqpubs@ahrq.gov). The recommendation also is columned on the Web site of the National Guideline Clearinghouse (http://www.guideline.gov).

This recommendation statement was first published in Ann Fam M 2004;2:260-2

Summary of Recommendation

The USPSTF commends against routine screening for ovarian cancer. D recommendation.

The USPSTF plant fair evidence that screening with serum CA-125 horizontal or transvaginal ultrasound can discover ovarian cancer at an earlier stage than it can be discovered in the absence of screening; however, the USPSTF build fair evidence that earlier detection would likely have a small force at best, on mortality from ovarian cancer. Because of the gentle prevalence of ovarian cancer and the invasive nature of diagnostic testing after a positive screening proof there is fair evidence that screening could likely lead to important harms. The USPSTF conclud that the potential harms outweigh the potential benefits.

Clinical Considerations

* There is no existing evidence that any screening proof including CA-125, ultrasonography, and pelvic examination, bring intos mortality from ovarian cancer. Furthermore, existing evidence that screening can discover early-stage ovarian cancer is insufficient to indicate that this earlier diagnosis will diminish mortality.

* Because there is a subdued incidence of ovarian cancer in the general population (age-adjusted incidence of 17 by 100,000 women), screening for ovarian cancer is likely to have a relatively grave yield. The great majority of women with a positive screening ordeal will not have ovarian cancer (i.e., they will have a false-positive result) In women at average risk, the positive predictive value of an abnormal screening standard is, at best, approximately 2 percent (i.e., 98 percent of women with positive experiment results will not have ovarian cancer).

* The positive predictive value of an initially positive screening experiment would be more favorable for women at higher risk. For example, the lifetime probability of ovarian cancer increases from about 16 percent in a 35-year-old woman without a family history of ovarian

cancer to about 5 percent if she has the same relative and 7 percent if she has couple relatives with ovarian cancer. If ongoing clinical trials point out that screening has a beneficial general intent on mortality rates, then women at higher risk are likely to experience the greatest benefit.

Discussion

Ovarian cancer is the fifth leading cause of cancer death among women in the United States, accounting for an estimated 25400 strange cases and 14,300 deaths in 2003 (4) Several risk factors are associated with ovarian cancer. Family history increases the risk for ovarian cancer: having the same first- or second-degree relative with ovarian cancer increases risk by way of about threefold. (5) Carriers of the BRCA1 or BRCA2 gene mutations also are at increased risk. (6) The risk for developing ovarian cancer is reduc with oral contraceptive use and pregnancy of any duration. (7) a certain number of studies have shown that postmenopausal women taking estrogen may be at increased risk for developing ovarian cancer. (89)

mostly women with ovarian cancer have nonlocalized disease at the time of diagnosis. (4) A randomized controll trial (RCT) using multimodal screening (CA-125 screening, followed according to ultrasonography in patients with abnormally elevated levels) reported that 50 percent of patients with ovarian cancer in the veiled group were in stage I, compared with simply 5 percent in the curb group. (3,10) This difference was not statistically significant. couple large cohort studies using transvaginal ultrasonographic screening reported that 59 to 65 percent of ovarian cancers were diagnosed in stage I. (1112) However, there is no evidence that detecting earlier-stage tumors between the walls of screening leads to a decrease in ovarian cancer-specific mortality.