On Feb. 13, the U.S. Preventive Services Task Force (USPSTF) published a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on screening for ovarian cancer. Based on its review of the evidence, the USPSTF recommended against this screening in asymptomatic women -- a "D" recommendation.(www.uspreventiveservicestaskforce.org)
"The task force recommends against screening for ovarian cancer in women who have no signs or symptoms," said USPSTF member Michael Barry, M.D., in a news release.(www.uspreventiveservicestaskforce.org) "Evidence shows that current screening methods do not prevent women from dying of ovarian cancer and that screening can lead to unnecessary surgery in women without cancer."
According to the task force, it's important to note that this recommendation doesn't apply to women who are at high risk for ovarian cancer, such as women with a BRCA gene mutation that is associated with hereditary breast and ovarian cancer syndrome.
This final recommendation is consistent with the USPSTF's 2012 final and 2017 draft recommendation statements. The AAFP has mirrored the task force's decision in its own just-released final recommendation statement.
Currently, no major U.S. medical or public health organization recommends routine screening for ovarian cancer.
- The U.S. Preventive Services Task Force has released a final recommendation statement reaffirming that potential harms of screening for ovarian cancer outweigh the benefits and stating that asymptomatic women shouldn't be screened.
- This final recommendation doesn't apply to women who are at high risk for ovarian cancer, such as women known to have certain BRCA1 or BRCA2 genetic mutations.
- The AAFP mirrored the task force in its own final recommendation statement.
Scope of Review
The USPSTF commissioned a review of the evidence on ovarian cancer screening to update its 2012 final recommendation that evaluated the benefits and harms of screening in asymptomatic, average-risk women.
Outcomes of interest included ovarian cancer mortality, quality of life, false-positive test result rates, surgery and surgical complication rates, and psychological effects of screening. Any screening approach (e.g., transvaginal ultrasound or CA-125 testing) that was evaluated in the clinical trials reviewed was included.
The task force identified three good-quality studies that examined how annual screening affected asymptomatic women not at high risk for ovarian cancer, and none of them found that screening significantly reduced ovarian cancer mortality.
The USPSTF also reviewed evidence on harms of ovarian cancer screening from these and a fourth fair-quality study that reported on quality of life and psychological harms of screening.
Across all the trials reviewed, the percentage of women randomized to screening who had surgery because of false-positive test results ranged from 0.2 percent to 3.25 percent. Of this group, 0 percent to 15 percent of participants experienced major surgical complications.
Response to Public Comment
During last summer's public comment period for the draft version of this recommendation, the task force received feedback from many commenters concerned that because ovarian cancer is aggressive and its symptoms often appear at later stages, screening tests that detect this type of cancer early should be recommended.
The USPSTF responded by noting that "evidence shows that currently available tests are not able to (detect ovarian cancer) and can lead to harm by causing healthy women to undergo surgical removal of their ovaries when no cancer is present."
Other commenters on the draft statement sought clarification regarding what factors would put a woman at high risk for ovarian cancer (and, thus, not covered by this recommendation). In response, the task force revised its final statement to clarify the role of family history in ovarian cancer risk and to describe the symptoms of the disease.
"Women with a family history of ovarian or breast cancer or symptoms should discuss this with their health care provider," the final recommendation noted.
The USPSTF further explained that it included primary peritoneal cancer in its ascertainment of ovarian cancer outcomes -- even if it was not the primary study end point -- because clinically, both types of cancer are diagnosed and treated as one disease. The task force also said its ascertainment of outcomes considered reports of both prevalent and incident cases of ovarian cancer, because screening would detect both.
"Ovarian cancer is a devastating disease, and we do not have a good way to identify women with ovarian cancer early enough to treat it effectively," said USPSTF member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E., in the release. "The task force is calling for research to find better screening tests and treatments that can help reduce the number of women who die from ovarian cancer."
Related AAFP News Coverage
AAFP Recommends Against Pelvic Exams in Asymptomatic Women
Guidance Differs From USPSTF Final Recommendation