Ovarian cancer screenings — either an ultrasound examination of the ovaries or a special blood test that looks for proteins associated with cancer — are not effective for women with an average risk of developing the disease and should not be routinely offered to them, a panel of government experts recommended on Monday.
Such screening does more harm than good, according to experts. It does not lower the death rate from the disease, but it does produce a high rate of false-positive results. Many women, therefore, end up undergoing unnecessary and risky surgery.
The evidence reviewed by the panel found that 10 percent of women receive false-positive results from ovarian cancer screening. One-third of those women then go on to have surgery to remove their ovaries. For every 20 women who have the surgery, one cancer is found. The surgery itself, however, leads to major medical complications for one of every five of the women who have it.
The panel’s recommendation does not apply to women with symptoms of the disease. Nor does it apply to high-risk women — those with a family history of the disease or a known genetic risk (such as an inherited BRCA gene mutation), although the panel found that high-risk women do not necessarily benefit from routine screening either. The experts recommended that high-risk women consider genetic counseling to further evaluate their ovarian-cancer risk — and whether or not they want to be screened.
Not surprising
Monday’s recommendation, made by the U.S. Preventive Services Task Force (USPSTF), is not a surprise. The panel made a similar recommendation in 2004 and 2008. In addition, no other major medical or public health group currently recommends ovarian screening for average-risk women. Yet despite this medical consensus, individual physicians often recommend ovarian screening to low-risk patients out of a mistaken belief that it saves lives.
A study published earlier this year that surveyed more than 1,000 family physicians, general internists and gynecologists found that one-third of the physicians believed that ovarian cancer screening was effective, despite evidence to the contrary.
“Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests,” that study concluded.
Disappointing
Although the USPSTF’s finding may not be surprising, it is disappointing. An effective method of screening for this deadly disease is urgently needed.
Ovarian cancer has the highest death rate of any gynecological cancer, and is the fifth leading cause of death among women in the United States. The American Cancer Society estimates that more than 22,000 women will be diagnosed with ovarian cancer this year and more than 15,000 will die from it. Half of the women who are diagnosed with the disease are over the age of 60.
Ovarian cancer is a “silent” disease, producing few noticeable symptoms until the cancer has spread within the pelvis and abdomen. When symptoms — such as persistent abdominal pressure or “fullness” and changes in bowel or bladder habits (like indigestion or frequent need to urinate) — do appear, they often mimic those of more common medical conditions. As a result, women tend to wait a long time before discussing them with their physician. By then the disease is often in a late stage and is very difficult to treat.
Needed: ‘something else’
Attempts are currently under way to find a way of eliminating the high rate of false-positive results associated with the current methods of ovarian screening, but many scientists remain skeptical.
“You can fine-tune it all you want to, and that still doesn’t change the bottom line,” one cancer expert told the New York Times. “I think it’s really important that both the physician and the public really learn and assimilate that this test as it’s currently delivered is not effective at reducing death rates from ovarian cancer. We’ve got to find something else.”
The USPSTF’s ovarian cancer recommendation was published in the Annals of Internal Medicine, where it can be read in full.
Dovetails nicely
with yesterday’s post.