Blog | Tuesday, October 9, 2012

Who could be against ovarian cancer screening?


The United States Preventive Services Task Force issued a recommendation against ovarian cancer screening.

1) Why did they do this?
2) Who do they think they are?
3) Isn't all screening for cancer (that might catch cancer early enough to be successfully treated) a good thing?

To answer these questions:
1) Because screening the general population, i.e. "average risk" women, makes no sense, medically or economically. [I would add to that, because of the first two, ethically also. That is, until there's a perfect test to screen for ovarian cancer, we're better off not doing it.]
2) Experts, unbiased by commercial ties.
3) No.

The USPSTF has a lot of enemies. Among them are cancer advocacy groups, cancer survivors and companies (both testing companies and medical enterprises) that make a lot of money from disease-mongering. Though it's unpopular to say it, and hits patients and families directly in the solar plexus when they've been through the medical ringer and simply don't want what happened to them happening to other people, non-evidence-based screening is wrong.

We only hear about the "successes." The message about screening is powerful. Anecdotes always are.

But there are many more people harmed by the cost, hassle, and anxiety caused by "abnormal" screening tests than benefit from it.

Lest you think I'm picking on women, I feel the same way about the PSA test for men. (Just ask my Dad.)

Lest you think I'm a total crackpot, I heartily support screening tests for cervical cancer (PAP smears) and colon cancer (colonscopies, and other sundry tests). The medical evidence supports them. I especially support vaccination. There. I said it. It's a medical no-brainer.

Ovarian cancer sucks. By the time it's diagnosed, it's usually in advanced stages which confers a very low five year survival rate (<26% if the cancer has spread to sites beyond the pelvis at the time of diagnosis).

I wish we had a screening test. But checking CA-125 in well women is a recipe for medical churn. It's great business for gynecologists. And for those few cases of ovarian cancer that are discovered (like looking for needles in haystacks), it's great for their GYN-oncologist brothers and sisters.

There are select populations in whom CA-125 and a pelvic ultrasound make sense: People whose mothers or sisters have/had ovarian cancer. People that have had the disease and are monitoring treatment. People testing positive or in families positive for BRCA-1 and 2 mutations.

I'd love to hear your thoughts about this. Chime in with a comment.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.