EARLY DETECTION AND SCREENING FOR OVARIAN-CANCER

Ovarian cancer is associated with postmenopausal women of North Americ an or European descent, nulliparous women, and women with a first-degr ee relative with an epithelial ovarian cancer. Methods for early detec tion of ovarian cancer are the pelvic examination, ultrasound techniqu es, and CA-125 monitoring, none of which are highly sensitive or speci fic for the disease. At the Yale-New Haven Medical Center, first-degre e relatives of women with epithelial ovarian cancer were invited to pa rticipate in an intense ovarian cancer screening program consisting of tumor markers, endovaginal ultrasound and color Doppler flow studies, and physical examinations performed in a serial fashion. The false-po sitive rate for the tumor markers varied from 2 to 9% at initial evalu ation of the first 247 participants. Endovaginal ultrasound and color Doppler flow techniques were used to evaluate 326 ovaries in 169 women . Resistive indices < 0.5 were present in 26 ovaries (8.4%), and peak systolic velocities > 30 cm/sec occurred in 7 ovaries (2.3%). To date, four breast cancers have been detected, three cervical intraepithelia l neoplasias have been identified, and three atypical adenomatous hype rplasias were diagnosed. No epithelial ovarian cancer was found. Isola ted screening for ovarian cancer even in high-risk women is not cost e ffective. Women screened for ovarian cancer should also be evaluated f or cancers of the breast, cervix, colon, rectum and endometrium. Isola ted abnormal screening test values are not an indication for surgery. (C) 1995 Wiley-Liss, inc.