Ovarian cancer screenings raise risk of health problems and do not reduce mortality

Ovarian cancer screenings raise risk of health problems and do not reduce mortality

Transvaginal ultrasound and the CA-125 blood test do not prevent females from dying of ovarian cancer - in fact the invasive medical procedures may be linked to health problems, researchers from the University of Alabama at Birmingham wrote in the Journal of the American Medical Association. The CA-123 blood test measures levels of a tumor marker which is more elevated in women with ovarian cancer, and some other cancers.

Edward Partridge, M.D., director of the UAB Comprehensive Cancer Center and president of the American Cancer Society Inc., said:

"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."

According to the American Cancer Society, approximately 21,880 women were diagnosed with ovarian cancer in 2010, in that same year 13,850 women died of the disease.

In the majority of cases the disease is diagnosed when the cancer is well advanced. Only about 30% of newly diagnosed patients survive for at least five years.

The trial set out to determine whether early detection - ovarian cancer screening - might improve prognosis.

The investigators gathered data on mortality results from the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial involving almost 80,000 females aged from 55 to 74 years at 10 screening centers across the USA between November 1993 and July 2001.

Half the participants had transvaginal ultrasound for four years and CA-125 annual screenings for six years. The other half had routine medical care but with no screenings. All the women were monitored for 12 years up to February 2010.

The researchers found that there was no statistical difference in the survival rates in the two groups. This suggests that simultaneous transvaginal ultrasound and CA-125 have no effect in disease-specific mortality for women with average ovarian cancer risk.

Not only do the screenings apparently not reduce mortality rates, they are also associated with nausea, bruising, bleeding and fainting, the researchers revealed. Unnecessary diagnostic tests caused by false positives may lead to heart problems, bowel injury and infection. 1,080 of the women with false-positive results had their ovaries surgically removed, and 222 of them had a major surgical complication.

Partridge added:

"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.

This study shows that we need better markers that are more sensitive and specific for the disease, along with improved imaging technologies. 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." "

"Effect of Screening on Ovarian Cancer Mortality - The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial"

Saundra S. Buys, MD; Edward Partridge, MD; Amanda Black, PhD, MPH; Christine C. Johnson, PhD, MPH; Lois Lamerato, PhD; Claudine Isaacs, MD; Douglas J. Reding, MD, MPH; Robert T. Greenlee, PhD, MPH; Lance A. Yokochi, MD, PhD; Bruce Kessel, MD; E. David Crawford, MD; Timothy R. Church, PhD, MS; Gerald L. Andriole, MD; Joel L. Weissfeld, MD, MPH; Mona N. Fouad, MD; David Chia, PhD; Barbara O'Brien, MPH; Lawrence R. Ragard, MD; Jonathan D. Clapp; Joshua M. Rathmell; Thomas L. Riley, BS; Patricia Hartge, ScD, MA; Paul F. Pinsky, PhD; Claire S. Zhu, PhD; Grant Izmirlian, PhD; Barnett S. Kramer, MD; Anthony B. Miller, MD; Jian-Lun Xu, PhD; Philip C. Prorok, PhD; John K. Gohagan, PhD; Christine D. Berg, MD

JAMA 2011;305(22):2295-2303. doi: 10.1001/jama.2011.766


Section Issues On Medicine: Women health