Effective screening for ovarian cancer is imperative because the disease incurs a high mortality rate and because effective treatment for early-stage disease exists.
The challenges in ovarian cancer screening lie in these principles: knowledge of the natural history of the disease is evolving, the disease incidence is low in the general population, and the preclinical phase can be estimated, but is not definitively known.
Transvaginal ultrasound (TVUS) offers excellent resolution of ovarian morphology, but false-positive results often lead to invasive surgeries for benign ovarian lesions.
CA-125 is the most widely studied tumor marker for ovarian cancer, yet it is elevated in only 50% of women with stage I ovarian cancer. False elevations are common in pre- and perimenopausal women. Screening for serial CA-125 levels, rather than using a fixed cutoff, may improve the detection of ovarian cancer.
Most current screening studies use both serum markers and radiologic imaging. The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the United Kingdom Collaborative Trial of Ovarian Cancer Screening are two large ongoing trials that are evaluating the effectiveness of ovarian cancer screening in the general population. No prospective, randomized trials have demonstrated a decrease in mortality rate from ovarian cancer screening in high-risk women, yet screening and early detection are important for high-risk women who have not yet chosen to undergo a bilateral salpingo-oophorectomy or who are unwilling to undergo this procedure.
Consensus groups recommend ovarian cancer screening for women with BRCA1 or BRCA2 mutations with 6-month ultrasound and CA-125 levels test because of the significant risk of ovarian cancer.
The ability to bank serum in both low- and high-risk populations in prospective screening studies is crucial, because a large number of candidate tumor markers are being investigated. The limitations of ovarian cancer screening should be stressed to all patients, but particularly to women with a high risk of ovarian cancer.
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