Can Ovarian Cancer Screening Cause Harm in Women Without Symptoms?
According to a draft of new guidelines relating to screening, ovarian cancer screening in young women who have no symptoms can cause harm and offers no benefits. According to the U.S. Preventative Services Task Force (USPSTF), the screening is not recommended for many women without symptoms. The U.S. Preventative Services Task Force is a group of experts who review and formulate recommendations about screening, counseling, and other healthcare preventative services.
According to the task force, current available diagnostic tools, such as transvaginal ultrasound and CA-125 blood test, are poor predictors of the cancer. In fact, evidence shows that several women who test positive do not proceed to develop ovarian cancer. The task force supports its recommendations based on ovarian cancer research and several clinical trials conducted with different screening approaches. According to these trials, screening did not greatly decrease the rate of ovarian cancer deaths. The draft recommendations do not apply to women with inherited gene mutations – BRCA1 and BRCA2.
Recent research
The most recent trial, known as UKCTOCS, involved the participation of over 200,000 postmenopausal women between the ages of 50 and 74. Each postmenopausal woman had to meet one of the following criteria:
- Having had no family history of ovarian cancer
- Having had no prior ovarian malignancy
- Having had no prior bilateral oophorectomy
- Having received more than 12 months of HR therapy for menopausal symptoms
- Not having had menstruation for more than 12 months after natural menopause or hysterectomy
The women were divided into three groups. The first group receives a transvaginal ultrasound, the second group received a CA-125 blood test, and the third group received no screening. After a follow-up period of 11 years and 1 month, the results revealed similar findings in all three groups. In addition, the PLCO trial compared the death rates among the screening and non-screening groups after 12 years and 4 months. The results revealed no differences between the groups. The overall objectives of the UKCTOCS trial sought to:
- Determine the impact of ovarian cancer screening in postmenopausal women;
- Compare and contrast screening for ovarian cancer using CA-125 testing and transvaginal ultrasound;
- Compare and contrast the mortality rates of women who underwent screening and those who did not;
- Determine the psychological consequences of the screening results;
- Compare the overall performance results of such screening methods in this general population
False indicators
According to the USPSTF, when a test indicates that a woman has ovarian cancer and she doesn’t actually have it, she may choose to undergo ovarian surgery that will prove to be unnecessary. Based on evidence from clinical trials, the task force suggests that screening for ovarian cancer in the general population is not recommended. Though routine screening it not recommended, commonly suggested methods such as transvaginal ultrasound and CA-125 blood testing are readily available. For women who are at higher risk of developing the cancer due to inherited gene mutations, the task force suggests doctors consider a combination of a CA-125 blood test, a pelvic examination, and a transvaginal ultrasound.
Varying risk levels
Recommendations for ovarian cancer screening have been divided into two groups: one group for women at average risk of ovarian cancer and the second group for women at an increased risk of ovarian cancer. The set of screening guidelines suggest that if you are at risk close to that of the general population, you should not undergo ovarian cancer screening but rather a gynecologic examination along with a pelvic examination at least once a year. If you have an increased risk of developing ovarian cancer, you should carefully consider both the benefits and risks of ovarian cancer screening. If you choose to undergo screening, it should be done within the appropriate framework based on your individual case. Moreover, if you have an inherited risk of ovarian cancer, it is recommended that you undergo ovarian cancer screening using a combination of CA-125 blood testing and transvaginal ultrasound.
Ovarian cancer is one of the most common types of cancer in women. It refers to cancer of the ovaries, which are a pair of small organs located on either side of the uterus. Approximately 22,000 women in the United States are diagnosed with ovarian cancer on an annual basis. In many instances, ovarian cancer does reveal any symptoms in its early stages. Nonetheless, according to the National Cancer Institute, if ovarian cancer is diagnosed at an early stage, the five year survival rate is seen at 94%.
Causes still unclear
According to the American Cancer Society, it remains unclear as to what exactly causes ovarian cancer. However, it has been found that a small percentage of ovarian cancers occur in women with inherited gene mutations, known as BRCA1 and BRCA2 genes. These genes have been linked to an increased risk of the disease. Other risk factors that are linked to a higher probability of developing ovarian cancer include:
- Being over the age of 65
- Being overweight
- Being a smoker
- Having a personal history of endometriosis
- Having a personal history of breast cancer
- Having polycystic ovary syndrome
- Having a family history of ovarian cancer
- Starting menopause at an earlier age
- Never having given birth
- Having undergone fertility treatment
- Having undergone long term hormone replacement therapy
If you fear that you may have ovarian cancer, it is important to consult with your doctor about undergoing a vaginal examination. He or she will check for any signs of abnormalities in the ovaries or uterus. They will also take a look at your personal medical history and family history to rule out any suspicions. If you receive a diagnosis of ovarian cancer, your doctor will want to identify the cancer’s stage and grade. The stage of the cancer refers to what areas in your body the cancer has spread to, whereas the grade of the cancer refers to whether the cancer cells appear normal or malignant. By properly identifying the stage and grade of the cancer, your doctor will be able to decide upon the best treatment plan for your individual case. The following are the most commonly suggested methods used to screen and diagnose ovarian cancer:
Treatment for ovarian cancer typically involves surgery, chemotherapy, a combination of the two, and every so often, radiotherapy. The type of treatment you will receive depends on several factors, including the type of ovarian cancer you have, its stage and grade, as well as your overall well-being. The new guidelines for ovarian cancer screening have been set in such a way as to show the difference between women with a definite inherited risk of developing ovarian cancer and women with a family history of the disease. Evidence shows that if you have a family history of breast cancer and yet no genetic inheritance of BRCA1 and BRCA2 genes, you may not necessary be at an increased risk of developing ovarian cancer. Due to this and given the limitations of ovarian cancer screening, you may want to consider genetic counseling and testing before undergoing ovarian cancer screening or other types of treatment that may prove to be unnecessary.
References
http://www.medicalnewstoday.com/articles/159675.php
https://clinicaltrials.gov/ct2/show/NCT00058032?term=UKCTOCS&rank=1
https://www.mskcc.org/cancer-care/types/ovarian/screening/screening-guidelines-ovarian
