U.S. Preventive Services Task Force

Screening for Ovarian Cancer: Recommendation Statement

 

Am Fam Physician. 2018 Jun 15;97(12):online.

Related Putting Prevention into Practice: Screening for Ovarian Cancer.

As published by the U.S. Preventive Services Task Force.

Summary of Recommendation and Evidence

The USPSTF recommends against screening for ovarian cancer in asymptomatic women (Table 1). D recommendation.

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TABLE 1.

Screening for Ovarian Cancer: Clinical Summary of the USPSTF Recommendation

Population

Asymptomatic women without a known high-risk hereditary cancer syndrome

Recommendation

Do not screen for ovarian cancer in asymptomatic women.

Grade: D

Risk assessment

Women with certain hereditary cancer syndromes are at high risk for ovarian cancer. Women with a family history of ovarian or breast cancer may be at risk for a hereditary cancer syndrome and should discuss their family history with their health care professional. The clinical symptoms of ovarian cancer (e.g., abdominal pain or pressure, bloating, constipation, urinary symptoms, back pain, or fatigue) are nonspecific and may be present in both healthy women and women with late-stage ovarian cancer; therefore, use of clinical symptoms for risk stratification for the early detection of disease is difficult.

Screening tests

The USPSTF does not recommend routine screening for ovarian cancer using any method. Transvaginal ultrasound and serum cancer antigen 125 testing are readily available procedures that are commonly used to evaluate women with signs or symptoms of ovarian cancer and have been evaluated in screening studies. Pelvic examination is also commonly performed to evaluate women with lower abdominal symptoms.

Treatments

Treatment of ovarian cancer typically includes surgical treatment (staging or debulking) and intraperitoneal, intravenous, or combined chemotherapy.

Other relevant USPSTF recommendations

The USPSTF recommends that women with a family history indicating they are at risk for a deleterious gene mutation (BRCA1 or BRCA2) be referred for genetic counseling and, if indicated, genetic testing. The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening with pelvic examination to detect a range of gynecologic conditions in asymptomatic, nonpregnant women.


Note: For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, go to https://www.uspreventiveservicestaskforce.org/.

USPSTF = U.S. Preventive Services Task Force.

TABLE 1.

Screening for Ovarian Cancer: Clinical Summary of the USPSTF Recommendation

Population

Asymptomatic women without a known high-risk hereditary cancer syndrome

Recommendation

Do not screen for ovarian cancer in asymptomatic women.

Grade: D

Risk assessment

Women with certain hereditary cancer syndromes are at high risk for ovarian cancer. Women with a family history of ovarian or breast cancer may be at risk for a hereditary cancer syndrome and should discuss their family history with their health care professional. The clinical symptoms of ovarian cancer (e.g., abdominal pain or pressure, bloating, constipation, urinary symptoms, back pain, or fatigue) are nonspecific and may be present in both healthy women and women with late-stage ovarian cancer; therefore, use of clinical symptoms for risk stratification for the early detection of disease is difficult.

Screening tests

The USPSTF does not recommend routine screening for ovarian cancer using any method. Transvaginal ultrasound and serum cancer antigen 125 testing are readily available procedures that are commonly used to evaluate women with signs or symptoms of ovarian cancer and have been evaluated in screening studies. Pelvic examination is also commonly performed to evaluate women with lower abdominal symptoms.

Treatments

Treatment of ovarian cancer typically includes surgical treatment (staging or debulking) and intraperitoneal, intravenous, or combined chemotherapy.

Other relevant USPSTF recommendations

The USPSTF recommends that women with a family history indicating they are at risk for a deleterious gene mutation (BRCA1 or BRCA2) be referred for genetic cou


This recommendation statement was first published in JAMA. 2018;319(6):588–594.

The “Other Considerations,” “Discussion,” “Update of Previous USPSTF Recommendation,” and “Recommendations of Others” sections of this recommendation statement are available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/ovarian-cancer-screening1.

The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

References

show all references

1. US Cancer Statistics Working Group. United States Cancer Incidence(USCS): 1999–2014 cancer incidence and mortality data. https://nccd.cdc.gov/uscs/. Accessed December 19, 2017....

2. National Cancer Institute. Cancer stat facts: ovarian cancer. https://seer.cancer.gov/statfacts/html/ovary.html. 2017. Accessed December 19, 2017.

3. Henderson JT, Webber EM, Sawaya GF. Screening for Ovarian Cancer: An Evidence Review for the US Preventive Services Task Force. Evidence synthesis no. 157. AHRQ publication no. 17-05231-EF-1. Rockville, Md.: Agency for Healthcare Research and Quality; 2018.

4. Henderson JT, Webber EM, Sawaya GF. Screening for ovarian cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(6):595–606.

5. National Academies of Sciences, Engineering, and Medicine. Ovarian Cancers: Evolving Paradigms in Research and Care. Washington, DC: National Academies Press;2016.

6. Stormo AR, Cooper CP, Hawkins NA, Saraiya M. Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women. Prev Med. 2012;54(6):415–421.

7. US Preventive Services Task Force. Screening for gynecologic conditions with pelvic examination: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(9):947–953.

8. Buys SS, Partridge E, Black A, et al.; PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–2303.

9. Doroudi M, Kramer BS, Pinsky PF. The bimanual ovarian palpation examination in the Prostate, Lung, Colorectal and Ovarian cancer screening trial: performance and complications. J Med Screen. 2017;24(4):220–222.

10. U.S. Preventive Services Task Force. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(4):271–281.

11. National Cancer Institute. Genetics of breast and gynecologic cancers (PDQ®)–health professional version. https://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq. 2017. Accessed December 20, 2017.

This summary is one in a series excerpted from the Recommendation Statements released by the USPSTF. These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and preventive medications.

The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF website at https://www.uspreventiveservicestaskforce.org/.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf.

 

 

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