SCREENING FOR OVARIAN-CANCER

Purpose: To critically review the available evidence for screening asy mptomatic women for ovarian cancer with ultrasonography or the CA 125 radioimmunoassay (CA 125) or both. Data Sources: A MEDLINE search of t he English-language literature and bibliographies of published studies providing estimates of ovarian cancer risk and test operating charact eristics (based on observational studies and meta-analyses) and effect iveness of treatment according to stage of disease (based on randomize d trials). Published mathematical models simulating screening for ovar ian cancer in specific populations were also included. Death from ovar ian cancer and morbidity from surgical procedures were the principal o utcomes considered. Results: Age and family history are the most impor tant risk factors for ovarian cancer. Annual screening with CA 125 or ultrasound in women older than 50 years without a family history of ov arian cancer would result in more than 30 false-positive results for e very ovarian cancer detected. False-positive tests are likely to requi re invasive testing, often including laparotomy. There is currently no direct evidence that mortality from ovarian cancer would be decreased by screening. Conclusions: Available evidence does not support either screening of pre- or postmenopausal women without a family history of ovarian cancer or routine screening in women with a family history of ovarian cancer in one or more relatives (without evidence of a heredi tary cancer syndrome). Women from a family with the rare hereditary ov arian cancer syndrome are at high risk for the disease and should be r eferred to a gynecologic oncologist.