Task Force Questions Value of Ovarian Screening Test
In what’s becoming a pattern of late, another cancer screening test has been deemed overused and unnecessary by the U.S. Preventive Services Task Force (USPSTF). The independent group of experts in prevention and evidence-based medicine has determined that tests for screening healthy women for ovarian cancer are more harmful than beneficial, and should not be routinely performed.
The screenings involve a blood test to detect the presence of substances linked to cancer and ultrasound scans that examine the ovaries. The USPSTF concluded that not only do they set off many false alarms (false-positives), they don’t lower the death rate from the disease.
If this sounds familiar to you, it’s probably because the same body has concluded the same thing recently about screenings for prostate and breast cancers. And several months ago, our blog “Medical Boards Advise Fewer Tests for Many Patients” discussed how the medical community enumerated 45 procedures whose routine use should be limited.
“There is no existing method of screening for ovarian cancer that is effective in reducing deaths,” Dr. Virginia A. Moyer, chairwoman of the expert USPSTF, told the New York Times last week. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery.”
The panel made clear that the advice to decline these screening applies only to healthy women with an average risk of ovarian cancer. For some people, such as those with suspicious symptoms, family history of the disease or who have certain genetic markers, the potential benefit to screening can outweigh the potential harm.
The panel’s research was published in the Annals of Internal Medicine, and, as The Times points out, its conclusions are based on medical evidence, not cost. And this isn’t the panel’s first such warning: It’s reaffirming its own advice from 2004.
“Although the task force has sometimes drawn fire in the past,” The Times noted, “particularly with its stand on mammograms, it has plenty of support in this case. Other medical groups, including the American Cancer Society and the American Congress of Obstetricians and Gynecologists, have for years been discouraging tests to screen for ovarian cancer.”
But some doctors still advise patients to have the screenings, and many patients ask for it in the hope test can detect the presence of disease early enough to save their lives. “We are fueled by hope,” Moyer told The Times. “It’s such a terrible disease. Almost everyone knows somebody’s who’s had it, and that means somebody who’s died of it. You get the feeling you should do anything possible to avoid that situation, but it’s easy to forget that what you do to avoid it can make matters worse.”
Ovarian cancer usually is fatal, and, from the time of diagnosis, quickly—by the time it’s diagnosed, usually it’s quite advanced. According to the American Cancer Society, more than 22,000 women will be diagnosed this year, and 15,500 will die.
The panel found a recent, large study particularly persuasive: As published last year in The Journal of the American Medical Association (JAMA) half of more than 78,000 women ages 55 to 74 were screened and half were not. Screening was ultrasound exams and blood tests for elevated levels of a factor called CA-125, which can be a sign of ovarian cancer.
The death rate from ovarian cancer, after 11 to 13 years, was the same for both groups.
Among the screened subjects, nearly 1 in 10 had false-positive results. More than 1,000 of those women had surgery, usually to remove one or both ovaries. After the surgeries it was clear that they had been unnecessary. And at least 15 in 100 of the surgical subjects experienced at least one serious complication, such as blood clots, infections or surgical injuries to other organs.
To find one case of ovarian cancer, 20 women had to undergo surgery.
Screening is not definitive—or, clearly, often even helpful; CA-125 can be elevated, as The Times explains, by conditions other than cancer, and ultrasound can reveal ovarian disorders that aren’t threatening but also indistinguishable from cancer unless surgery is performed to remove it.
Reader comments to The Times’ story, as might be expected, confirmed both the wisdom of the panel’s recommendation, and the personal experience of individuals who got screened and were grateful they did.
One commenter who identified himself as a cancer professor said, “Pretty much any adult has at least one, probably multiple cancerous tumors somewhere in their body. Scary but true. The large majority of them won't ever grow much, and something else will kill you long before it will. With bad luck one of yours will be aggressive and make itself known. Remember, most tumors have probably been growing in your body for many years,…”
“Now enter new, much more sensitive screening technologies, both imaging and biochemical. Guess what? We start removing all of those little tumors that will never kill you. Sure, some of them might kill you. But statistically you are more likely to get screwed up and die from surgery/chemo/radiation than you are the small chance that we detected the tumor earlier. It's all odds. Psychologically it may make you feel better to be doing something, but every shred of medical evidence argues that it is better to avoid a procedure unless that procedure is PROVEN to have a substantial benefit…”
“Just because you can find a tumor doesn't mean you should remove it. There are a lot of great new targeted drugs coming out, and we're starting to tailor them to the genotype of tumors. That's the ticket.”
If you’re in good health and don’t have any of the risk factors, the best advice doctors have for women concerned about ovarian cancer is to pay attention to first-warning symptoms. Contact your doctor if you have:
- persistent bloating;
- pelvic or abdominal pain;
- a feeling of fullness early when you eat; and/or
- the need to urinate frequently.
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