Blog | Tuesday, November 22, 2011

Ovarian cancer screening has no value


If you want to create an outcry of indignation, just inform people that certain screening tests are of no value and do not increase time on this earth. People love the idea that if they do all the right things and get all the medical tests at the right time, they can prevent disease (... Uh ... no, tests don't prevent anything.) or catch cancer early and cure it.

Ovarian carcinoma echogram from Practical Gynecology, copyright American College of PhysiciansThe furor over the lack of benefit for men of the screening Prostate Specific Antigen test (PSA) is still being heard. It seems everyone knows someone who was "saved" by getting a PSA and don't try to tell me there is evidence to suggest otherwise, dammit!

There is a new report in the Journal of the American Medical Association (JAMA) that confirms previous studies and shows there is no benefit for women to obtaining screening ultrasounds and Ca125 for ovarian cancer. This is bad news because every year over 21,000 women are diagnosed with ovarian cancer. Most of them are diagnosed in advanced stages and the five-year survival rate is only 30%. Of course we want a safe, effective screening test that can detect abnormalities early.

Ca125 (blood test) and transvaginal ultrasounds should work, but they don't. The 13-year-old study confirmed a prior report that the predictive value of these tests was low and additionally it confirmed there was no difference in mortality in women who underwent screening compared with those who did not. Additionally they found a high number of false positive tests and 15% of women with false positives suffered serious complications of surgery.

The discouraging findings may be because ovarian tumors are aggressive and annual screening is ineffective. The serious complications associated with false positive tests also makes it a bad screening test for the population.

Someday we will find good tests to detect these cancers. Right now patients and doctors should just say, "No."

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.