AAFP, USPSTF Recommend Against Routine Screening for Ovarian Cancer

The AAFP, in conjunction with the U.S. Preventive Services Task Force (USPSTF), has reaffirmed its 2004 recommendation against screening for ovarian cancer in women. The updated recommendation applies only to asymptomatic women. Women with known genetic mutations that increase their risk for ovarian cancer are not included in the recommendation.

Despite having the highest mortality rate of all gynecologic malignancies and being the fifth-leading cause of cancer death among women, the bottom line when it comes to screening for ovarian cancer, according to family physician and USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., is that no screening method exists that is effective in reducing deaths.

"In addition, a high percentage of women who undergo screening will experience a false-positive test and consequently be subjected to unnecessary harms, such as major surgery," LeFevre told AAFP News Now. "Ovarian cancer is … a major cause of cancer death in women, but unfortunately, we don't have an effective way to screen that saves lives, and the methods that we do have available are associated with very high false-positive rates. Therefore, we do a lot of harm without benefit."

Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, chair of the Department of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, Phoenix, and the AAFP liaison to the USPSTF, said that not only did a 2008 review reveal no new evidence to support screening for ovarian cancer, it also provided new data regarding observable harms. With a 2011 bridge search confirming those results, he said the evidence against screening is as cut-and-dried as it gets.

"It's clearly something that physicians should not do," Campos-Outcalt said. "They should not be screening for ovarian cancer because it simply does not work, and it will lead to a bunch of unnecessary follow-up testing and interventions that aren't going to make any difference in the outcome."

LeFevre said it is important to point out that the recommendation applies to asymptomatic women without a known genetic mutation, such as in the BRCA1 or BRCA2 gene, that increases the risk for ovarian cancer.

"I don't think we have good information about what to do with those patients," he said, "but this recommendation doesn't apply to them."

The Academy and the task force are in good company with regard to their position on screening for this disease, according to LeFevre. Many other major health and medical associations, including the American Cancer Society and the American College of Obstetricians and Gynecologists also recommend against screening asymptomatic women with no known risk factors for ovarian cancer.