Screening for Ovarian Cancer: Recommendation Statement

U.S. Preventive Services Task Force

doi:10.1370/afm.200

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U.S. Preventive Services Task Force response to letters about the recommendation on ovarian cancer screening
Ned Calonge, MD, MPH

Published on: 14 September 2004
The Patient's point of view!
Laurel J. Pracht

Published on: 30 June 2004
CA 125 vs PSA
sean patrick

Published on: 29 June 2004
Ovarian cancer symptoms
Stephanie L Whitaker

Published on: 29 June 2004
Ovarian Cancer Screening
Michael A Quinn

Published on: 27 May 2004

Published on: (14 September 2004)
Page navigation anchor for U.S. Preventive Services Task Force response to letters about the recommendation on ovarian cancer screening
U.S. Preventive Services Task Force response to letters about the recommendation on ovarian cancer screening
Ned Calonge, MD, MPH, Rockville, MD, United States
Other Contributors:
We appreciate the patient perspectives expressed in the letters by Laurel Pracht and Stephanie Whitaker on the U.S. Preventive Services Task Force (Task Force) recommendation on screening for ovarian cancer. Patients’ experiences provide valuable insights about cancer screening, diagnosis, and treatment. These letters as well as those of Sean Patrick and Michael Quinn raise several issues that warrant clarification about...
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We appreciate the patient perspectives expressed in the letters by Laurel Pracht and Stephanie Whitaker on the U.S. Preventive Services Task Force (Task Force) recommendation on screening for ovarian cancer. Patients’ experiences provide valuable insights about cancer screening, diagnosis, and treatment. These letters as well as those of Sean Patrick and Michael Quinn raise several issues that warrant clarification about the mission, scope, and methods of the Task Force.
The mission of the Task Force has, for the past 20 years, been to systematically review the scientific evidence of the effectiveness of clinical preventive services intended for use in the primary care setting and to make recommendations about their delivery. The patients to whom Task Force recommendations apply are those who have no symptoms of disease, whether or not they are at risk. In making its recommendations, the Task Force carefully weighs the benefits and harms of providing the service, based on the evidence available at the time.
Therefore, the ovarian cancer screening recommendation1 and the systematic evidence review supporting it focused on screening women with no symptoms of this disease rather than on case-finding among women with symptoms; this is why applying tests such as CA-125 or ultrasound to patients with either symptoms or known mutations in order to diagnose ovarian cancer was outside of the scope of this Task Force recommendation Of note, USPSTF is in the process of reviewing the literature on screening for breast and ovarian cancer using BRCA genetic testing and anticipates release of this recommendation in late 2005/early 2006..
Upon reviewing the literature, the Task Force found that although screening with serum CA-125 level or transvaginal ultrasound can detect ovarian cancer among asymptomatic women at an earlier stage, there was little evidence that such earlier detection reduces mortality from ovarian cancer. In addition, there are significant harms associated with screening and subsequent invasive diagnostic work-up.
Because the incidence of ovarian cancer in the general population is very low (17 per 100,000 women), screening for ovarian cancer with currently available tests is likely to have a low yield. In fact, 98% of women with a positive screening test will not have ovarian cancer; however, these women undergo unnecessary and potentially harmful invasive procedures, including surgery, as a result. The Task Force therefore concluded that there is a net harm associated with screening all women in the general population for ovarian cancer.
The Task Force has applied its methodology and the same standards of evidence to other preventive services, including prostate cancer screening, 2 for which insufficient evidence was found to recommend either for or against providing this service.
It is important to underscore that not all screening is beneficial or leads to improved health outcomes. Consistent with the longstanding commitment by physicians and other health care professionals to ‘first do no harm,’ providing services to individuals who are apparently free of disease requires a careful approach to balancing benefits and harms.
1 U.S. Preventive Services Task Force. Screening for ovarian cancer: recommendation statement. Ann Fam Med 2004; 2: 260-262. 2 U.S. Preventive Services Task Force. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002;137:915-916.
Ned Calonge, MD, MPH Janet D. Allan, PhD, RN, CS U.S. Preventive Services Task Force Rockville, Maryland 20850
Competing interests: None declared
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Competing Interests: None declared.
Published on: (30 June 2004)
Page navigation anchor for The Patient's point of view!
The Patient's point of view!
Laurel J. Pracht, Broken Bow, NE, USA
Regarding the recommendation to NOT routinely screen women for ovarian cancer, I totally disagree! With all the symptoms of ovca, no physician was able to dx it. They said I had IBS or had anxiety. Anxiety is finally learning I had a 13+ CM ovarian mass, metastasized to the omentum, and after surgery was staged at 111C, grade 3 and given "perhaps 5 years with chemo" as a future. Had I had a screening for ovca during...
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Regarding the recommendation to NOT routinely screen women for ovarian cancer, I totally disagree! With all the symptoms of ovca, no physician was able to dx it. They said I had IBS or had anxiety. Anxiety is finally learning I had a 13+ CM ovarian mass, metastasized to the omentum, and after surgery was staged at 111C, grade 3 and given "perhaps 5 years with chemo" as a future. Had I had a screening for ovca during the previous 2 years of seeing one physician after another, my prognosis would have differed greatly.
Your study states ovca is very rare, 17 cases in 100,000 women, however to those 17 women the statistics were 100%. If they'd had viligiant screening for this vicious disease, there's little doubt the outcome would be much more positive. This study seems very biased toward continuing the myth that ovca has "no symptoms" and is the cancer that whispers. That's untrue, a woman knows her body, but if you promote physicians to deny screening for ovarian cancer we shall continue to die of this disease.
A survivor......... so far.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (29 June 2004)
Page navigation anchor for CA 125 vs PSA
CA 125 vs PSA
sean patrick, USA
The PSA is no more accurate than the CA 125, yet when it became the gold standard for prostate screening, it was found that it was a much more accurate test used serially. In the 10 years it has been used routinely, 5 year survival for prostate cancer has gone from 67% to 96% while after 10 years ovarian cancer survival hovers around 50%.
In fact, ovarian cancer, according to the ACS recently released statist...
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The PSA is no more accurate than the CA 125, yet when it became the gold standard for prostate screening, it was found that it was a much more accurate test used serially. In the 10 years it has been used routinely, 5 year survival for prostate cancer has gone from 67% to 96% while after 10 years ovarian cancer survival hovers around 50%.
In fact, ovarian cancer, according to the ACS recently released statistics, has seen of jump in deaths by close to 20% from 14,300 to 16,900 now making it the fourth leading cause of cancer death among women.
This represents a gender bias and a societal value bias vis a vis the value of older men vs the value of older women. We are not concerned about all the false positives and costs of biopsy in men or the anxiety it causes when it comes to the PSA - yet we are with women.
While the incidence of prostate cancer is higher the average age at onset is 72- and 96% survive 5 years- we are more concerned about this problem then we are about ovarian cancer - where the death rate has gone up.
Discrepancies in funding between the 2 cancers also points to a significant gender bias -
The reasoning behind using the inaccurate PSA as the gold standard was, it was the best test there was - the same should be applied to ovarian cancer and a CA 125 ROCA model with TVUS should be used. Given the fact 90% of ovarian cancer is sporadic, just screening those at risk will not appreciably reduce mortality.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (29 June 2004)
Page navigation anchor for Ovarian cancer symptoms
Ovarian cancer symptoms
Stephanie L Whitaker, Orlando, FL
I was diagnosed with ovarian cancer Sept. 2003. One of my symptoms was weight gain due to a basketball size tumor on the right side of my abdomen. Review of medical literature states that weight gain is often a symptom of ovarian cancer.
Therefore, the statement that "unexplained weight loss" is a symptom not true.
I also had heartburn before my diagnosis of ovarian cancer, which is another symptom of...
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I was diagnosed with ovarian cancer Sept. 2003. One of my symptoms was weight gain due to a basketball size tumor on the right side of my abdomen. Review of medical literature states that weight gain is often a symptom of ovarian cancer.
Therefore, the statement that "unexplained weight loss" is a symptom not true.
I also had heartburn before my diagnosis of ovarian cancer, which is another symptom of ovarian cancer.
I believe that other symptoms of ovarian cancer besides abdominal and pelvic pain should have been noted. Along with weight gain and heartburn, other symptoms of ovarian cancer include bloating, frequent or urgent urination, constipation, diarrhea, and menstrual disorders.
I am requesting a reply to this letter from the author.
Sincerely, Stephanie Whitaker RN MSN- Diagnosed with ovarian cancer 9/03 and currently in remission
Competing interests: None declared
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Competing Interests: None declared.
Published on: (27 May 2004)
Page navigation anchor for Ovarian Cancer Screening
Ovarian Cancer Screening
Michael A Quinn, Melbourne Australia
This statement is clearly appropriate given the lack of Level 1 evidence and the potential harm that ad hoc screening for ovarian cancer might cause. It was a little disappointing not to see any recommendation about screening the high risk woman and in particular those with known or putative mutations,since the family doctor is the person most likely to be consulted in the first instance.
Competing interests: No...
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This statement is clearly appropriate given the lack of Level 1 evidence and the potential harm that ad hoc screening for ovarian cancer might cause. It was a little disappointing not to see any recommendation about screening the high risk woman and in particular those with known or putative mutations,since the family doctor is the person most likely to be consulted in the first instance.
Competing interests: None declared
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Competing Interests: None declared.