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USPSTF Recommends Against Non-High Risk Screening for Ovarian Cancer

NEW YORK (360Dx) – The U.S. Preventative Services Task Force today recommended against screening women for ovarian cancer unless they have symptoms or are known to be at high risk for the disease.

The USPSTF said it based its recommendation on findings that widespread screening for ovarian cancer has not been shown to reduce ovarian cancer mortality rates. In addition, the high false-positive rates of ovarian cancer screening and the potential complications of unnecessary surgeries for women who do not have cancer outweigh the potential benefits. The recommendation statement was published in the Journal of the American Medical Association.

The recommendation is a reaffirmation of the USPSTF's last recommendation issued in 2012 and has support in the medical community.

"In the general population ovarian is a relatively rare disease and the specificity of our current tests is not acceptable — false positives in ovarian cancer screening can result in unindicated surgeries," said Stephanie Blank, professor of gynecological oncology in the department of obstetrics, gynecology and reproductive sciences at the Icahn School of Medicine at Mount Sinai and director of women's health at Mount Sinai Downtown-Chelsea Center.

In a statement, Blank noted that the ovarian cancer screening is not always covered by insurers when symptoms or indications are not present, and said that women who think they might have an increased genetic risk should talk to their doctors about genetic counseling and testing. In addition, women need to be made aware of the symptoms of the disease, which include bloating, trouble eating, pelvic or abdominal pain, and urinary frequency, she said.

While early-stage ovarian cancer is curable, most of the 22,000 diagnoses made in the US each year are of late-stage cancer, which has a poor prognosis, Charles Drescher, a member of the public health science division of the Fred Hutchinson Cancer Center and Garnet Anderson, the division's senior vice president and director, wrote in an editorial published in a JAMA editorial published today titled The Yet Unrealized Promise of Ovarian Cancer Screening.

However, Drescher and Anderson noted that there is, so far, no strategy for early detection that reduces that mortality rate.

"There is now a strong and consistent voice advising against screening asymptomatic women for ovarian cancer as part of standard clinical care," Drescher and Anderson wrote, noting that developing better tools for risk assessment, prevention, and early detection remain priorities for researchers.

The largest and most recent trial on which the USPSTF recommendation was based was the UK Collaborative Trial of Ovarian Cancer Screening, a randomized trial of 202,638 postmenopausal women between the ages of 50 and 74, not known to be at high risk for ovarian cancer. Women were screened with CA-125 serum testing with triage and follow-up determined by the Risk of Ovarian Cancer Algorithm, or yearly transvaginal ultrasound. After average follow-up of 11 years, ovarian cancer mortality was not significantly different between the control group and the two intervention groups, with rates of .35 percent in the control group, .32 percent in the transvaginal ultrasound group, and .32 percent in the CA-125 ROCA group.

A draft version of the recommendation was first published on the USPSTF website for public comment in July. Some commenters expressed concern that any screening should be recommended due to the aggressive nature of the disease and the fact that symptoms often only appear in late stages.

"The USPSTF agrees that screening tests are needed that can accurately detect ovarian cancer earlier to prevent deaths from ovarian cancer; however the evidence shows that currently available tests are not able to do so and can lead to harm by causing healthy women to undergo surgical removal of their ovaries when no cancer is present," the recommendation stated in its response to public comment.