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screening for ovarian cancer

Indications: - USPSTF recommends against screening for ovarian cancer [1,7] except for women with a family history of ovarian cancer or breast cancer - American College of Physicians recommends against screening for ovarian cancer [4] - American College of Obstetricians and Gynecologists (ACOG) recommends against routine screening with CA-125 in serum or transvaginal ultrasound in BRCA mutation carriers or women with personal or family history [8] - screening with ultrasound may benefit high-risk patients [12] - no screening method has been shown to reduce mortality, even in high-risk women [13] * No ovarian cancer screening tests have been cleared by the FDA [5] Pathology: - many high-grade serous ovarian cancers originate in the fallopian tube, thus serous tubal carcinoma in situ may be an entity [10] - high-grade serous ovarian cancers are the most common subtype & the subtype with the highest mortality [11] Laboratory: - serum CA-125 - BRCA1/BRCA2 genotyping in women with a family history of breast cancer or ovarian cancer - BRCA1 promoter methylation in leukocytes is positively associated with risk for high-grade serous ovarian cancer [9] Special laboratory: - transvaginal ultrasound Management: - USPSTF recommends against screening for ovarian cancer [1,7], except for women with a family history of ovarian cancer or breast cancer - no proven benefit for screening high-risk women (MKSAP19) [3] - no mortality benefit to routine screening for ovarian cancer with transvaginal ultrasound &/or serum CA-125 testing [14] - harms of screening are at least moderate [1] - screening may detect ovarian cancers at earlier stage, but mortality is not improved [14] - annual screening for ovarian cancer might lower ovarian cancer-related mortality [6] - serum CA-125 with rising levels interpreted using an ovarian cancer algorithm & ultrasound as indicated - risk reduction of 20% realized after 7 years: NNT=641 - for each ovarina cancer detected by screening, 2 women underwent surgery for false positive screening [6]

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ovarian cancer

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screening for cancer

References

  1. Moyer VA et al Screening for Ovarian Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement Annals of Internal Medicine, 11 September 2012 PMID: 22964825 http://annals.org/article.aspx?articleid=1357339 (corresponding NGC guideline withdrawn Feb 2018)
  2. U.S. Preventive Services Task Force Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: U.S. Preventive Services Task Force Recommendation Statement. DRAFT. Summary of Recommendations and Evidence. available for comment from April 2 until April 29, 2013 http://www.uspreventiveservicestaskforce.org/draftrec.htm - Draft Evidence Report Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer. http://www.uspreventiveservicestaskforce.org/draftrep2.htm
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Wilt TJ, Harris RP, Qaseem A for the High Value Care Task Force of the American College of Physicians. Screening for Cancer: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162(10):718-725. PMID: 25984847 http://annals.org/article.aspx?articleid=2294149 - Harris RP, Wilt TJ, Qaseem A for the High Value Care Task Force of the American College of Physicians. A Value Framework for Cancer Screening: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162(10):712-717 PMID: 25984846 http://annals.org/article.aspx?articleid=2293237
  5. FDA Safety Alert. Sept 7, 2016 Ovarian Cancer Screening Tests: Safety Communication - FDA Recommends Against Use, http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm519540.htm
  6. Jacobs IJ et al Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. Dec 17, 2015 PMID: 26707054 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901224-6/abstract - Verheijen RH, Zweemer RP. Screening to improve ovarian cancer prognosis? Lancet. Dec 17, 2015 PMID: 26707055 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901236-2/abstract
  7. U.S. Preventive Services Task Force Draft Recommendation Statement. July 2017 Ovarian Cancer: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement174/ovarian-cancer-screening1 - U.S. Preventive Services Task Force (USPSTF) Draft Evidence Review. July 2017 Draft Evidence Review for Ovarian Cancer: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review166/ovarian-cancer-screening1 - US Preventive Services Task Force Screening for Ovarian Cancer. US Preventive Services Task Force Recommendation Statement JAMA. 2018;319(6):588-594. PMID: 29450531 https://jamanetwork.com/journals/jama/fullarticle/2672638 - Henderson JT, Webber EM, Sawaya GT. Screening for Ovarian Cancer. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(6):595-606 PMID: 29450530 https://jamanetwork.com/journals/jama/fullarticle/2672637
  8. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 182 Summary: Hereditary Breast and Ovarian Cancer Syndrome. Obstetrics & Gynecology. 130(3):657-659, SEP 2017 PMID: 28832475 https://insights.ovid.com/crossref?an=00006250-201709000-00035
  9. Lonning PE, Berge EO, Bjornslett M et al White Blood Cell BRCA1 Promoter Methylation Status and Ovarian Cancer Risk. Ann Intern Med. 2018 Jan 16. PMID: 29335712
  10. Narod SA Is There a Future for Ovarian Cancer Screening? JAMA Intern Med. Published online Feb 13, 2018 PMID: 29450456 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2672543
  11. Lu KH Screening for Ovarian Cancer in Asymptomatic Women. JAMA. 2018;319(6):557-558 PMID: 29450509 https://jamanetwork.com/journals/jama/fullarticle/2672614
  12. van Nagell JR Jr, Burgess BT, Miller RW et al. Survival of women with type I and II epithelial ovarian cancer detected by ultrasound screening. Obstet Gynecol 2018 Nov; 132:1091. PMID: 30303916 PMID: 30303916 https://insights.ovid.com/crossref?an=00006250-201811000-00002 - Robertson SE, Peipert JF. Ultrasound screening for ovarian cancer: Are we there yet? Obstet Gynecol 2018 Nov; 132:1089. PMID: 30303915 https://insights.ovid.com/crossref?an=00006250-201811000-00001
  13. Walker M, Jacobson M, Sobel M Management of ovarian cancer risk in women with BRCA1/2 pathogenic variants. CMAJ August 12, 2019 191 (32) E886-E893; PMID: 31405835 http://www.cmaj.ca/content/191/32/E886
  14. Menon U et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A randomised controlled trial. Lancet 2021 May 12; [e-pub] PMID: 33991479 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00731-5/fulltext