Screening for ovarian cancer: What we know, what we need to know

The majority of women with ovarian cancer present with advanced-stage disea se. Women with early-stage ovarian cancer have a much better chance of achi eving a cure than do women with late-stage disease. This difference makes s creening for ovarian cancer, with the hope of detecting it in its presympto matic state, an attractive concept. Unfortunately, efforts to demonstrate t hat screening for ovarian cancer in the general population can decrease mor tality have been disappointing. Current screening techniques do not have hi gh enough sensitivity and specificity to be applied to the general populati on, because the low prevalence of the disease in the general population lea ds to very low positive predictive values for the available screening tests . However, applying current screening strategies to certain high-risk popul ations (women who carry mutations in the BRCA1 or BRCA2 genes, or with stro ng family histories of breast/ovarian cancer) is a reasonable approach and may result in acceptably high positive predictive values. This article disc usses the results of screening studies using serum CA-125, sonography, othe r serum markers, and combinations of these tests. Screening for women of av erage risk is not recommended, although such women should be encouraged to participate in clinical trials whose endpoints are either the demonstration of the impact of screening on mortality, or the development of novel scree ning strategies. Screening with twice yearly transvaginal sonography and se rum CA-125 testing is recomnzended for women at high risk for ovarian cance r, although prospective data are needed regarding the impact of such screen ing on stage of cancer detected, quality of life, and psychological distres s, as well as the costs-both personal and societal-of screening.