Screenings appear not to reduce risk of ovarian cancer death

A common combination screen proved no more effective than non-screening, but scientists are finding new ways to prevent and treat the disease.

A University of Alabama at Birmingham study released today reports that ovarian cancer screenings do not reduce a woman’s risk of death from the disease and the invasive medical procedures may create associated health problems.

doc_patient_siteScientists from the UAB Comprehensive Cancer Center and colleagues from other institutions concluded that a common screening routine of transvaginal ultrasound and the CA-125, a blood test used to measure the level of a tumor marker produced in higher amounts in women with ovarian or other cancers, does not prevent a woman from dying from ovarian cancer.

“The message is clear: No woman should be getting a transvaginal ultrasound and CA-125 with the belief that it is going to impact her ultimate mortality. This is not an effective strategy, and it should not be implemented,” says Edward Partridge, M.D., director of the UAB Comprehensive Cancer Center and president of the American Cancer Society Inc.

Partridge and Mona Fouad, M.D., MPH, director of UAB’s Division of Preventive Medicine and its Minority Health and Health Disparities Research Center, are co-authors of the paper that appears in the June 8, 2011, cancer-themed issue of Journal of the American Medical Association.

Ovarian cancer is among the five leading causes of cancer death in women; in 2010 there were about 21,880 new diagnoses of ovarian cancer and about 13,850 deaths from the disease, according to the American Cancer Society. Most women with ovarian cancer are diagnosed in its advanced stages and have a five-year survival rate of 30 percent. The hope that early detection may improve prognosis prompted the trial to evaluate the efficacy of this common screening.

The researchers examined the ovarian cancer-specific mortality results from the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, which enrolled nearly 80,000 women, ages 55-74, between November 1993 and July 2001 at 10 screening centers across the United States. Half the women were screened annually with CA-125 for six years and transvaginal ultrasound for four years, and the other half had routine medical care without a screening. Both study groups were followed for a maximum 13 years until February 2010. 

The data revealed that the difference in survival between the two groups was not statistically significant, suggesting simultaneous CA-125 and transvaginal ultrasound does not reduce disease-specific mortality in women at average risk for ovarian cancer.

However, the screenings were associated with bleeding, fainting, nausea and bruising. False positives often resulted in unnecessary diagnostic tests that were associated with infection, heart problems and bowel injury. Of the women who received false-positive results, more than 1,080 had their ovaries removed; of those, more than 222 experienced a major surgical complication.  

“There is reasonable data in this study that shows that ovarian cancer-screening causes more harm than good; in fact it shows no good comes out of it,” says Partridge, co-chair of the ovarian committee of the PLCO. 

“This study shows that we need better markers that are more sensitive and specific for the disease, along with improved imaging technologies,” Partridge says. “We have scientists who are working in those areas, but more research and research funding is needed to help us better understand the beginnings of the disease, how it progresses and how we can prevent it.”

Other institutions involved were NCI, Huntsman Cancer Institute at University of Utah Health Sciences Center, Henry Ford Health System, Lombardi Cancer Center at Georgetown University, Marshfield Clinic Research Foundation, Pacific Health Research and Education Institute, Anschutz Cancer Pavilion at University of Colorado, University of Minnesota School of Public Health, Washington University School of Medicine, University of Pittsburgh Medical Center Cancer Pavilion, UCLA Immunogenetics Center, Westat Inc. Information Management Services and Dalla Lana School of Public Health at the University of Toronto.