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Screening for ovarian cancer: What you should know

The Bottom Line

  • Ovarian cancer can be difficult to detect in its early stages; going undiagnosed until it has already spread in about 50% of women.  
  • A transvaginal ultrasound and/or blood test are two options for ovarian cancer screening.  
  • Screening for ovarian cancer in women at average risk of the disease and who are symptomless is not recommended by the US Preventive Services Task Force.
  • Women are advised to speak with their health care provider about their risk of ovarian cancer and if screening is the right choice for them. 

Detecting ovarian cancer is a challenge (1). Early on, it's often symptomless. In its later stages, symptoms such as abdominal bloating, weight loss, pelvic pain, constipation, or frequent trips to the washroom can mimic those of more common, and potentially less serious conditions (1;2). In over half of women, ovarian cancer is not diagnosed until it has spread to other parts of the body (3-6). This makes it more difficult to treat. Roughly one-third of women with late stage ovarian cancer will still be alive five years after their diagnosis (5;7), and among the 80% of women who initially respond to treatment, the cancer will return in 70% of them (5;8).


Therefore, it’s important to know your risk. Being over the age of 50, having certain gene mutations or a family history of ovarian cancer, or using estrogen replacement therapy may put you at higher risk, as does starting menstruation early or entering menopause late (2).


Catching ovarian cancer early can improve your chances of beating the disease. The problem is that previous research has shown that ovarian cancer screening does not work well in symptomless women, and may even be harmful (3). In some cases, women who underwent screening were incorrectly given the all-clear, while other women were told they had cancer when they did not (3;9-11). In 2012, the US Preventive Services Task Force (USPSTF) recommended against screening for ovarian cancer in this population of women (3).


Since then, more research has emerged, prompting the USPSTF to undertake a new systematic review of the evidence around ovarian cancer screening in women who are over the age of 45, symptomless, and at “average risk” of the disease (that is, they have no family history of ovarian or breast cancer, or other high-risk cancers). They looked at ovarian cancer screening that was carried out by transvaginal ultrasound (an imaging test of the ovaries) and/or by a blood test (1;3).


So, does the new evidence change the previous recommendation?


What the research tells us

The review found that ovarian cancer screening, compared to no screening, does not lower the number of deaths from ovarian cancer. False-positive test results (when women tested positive for cancer but did not have the disease) also resulted in unnecessary surgeries (3).


Based on these findings, in 2018, the USPSTF recommended against ovarian screening in women with an “average risk” of ovarian cancer who do not have symptoms (1), a recommendation that is supported by the Canadian Task Force on Preventative Health Care (12). The Canadian Cancer Society also recommends that women at higher risk of ovarian cancer speak with their doctor to develop a personal plan for ovarian cancer screening (13).


As always, you should speak with your health care provider about the pros and cons of ovarian cancer screening, and whether it is a good choice based on your own health, risk factors, and preferences. You should also speak with your health care provider if you have concerning symptoms.


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References

  1. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Ovarian Cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018; 319(6):588-594. doi: 10.1001/jama.2017.21926. 
  2. Mayo Clinic. Ovarian cancer. [Internet] 2019. [cited August 2019]. Available from https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941
  3. Henderson JT, Webber EM, Sawaya GF. Screening for ovarian cancer: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018; 319:595-606. doi: 10.1001/jama.2017.21421. 
  4. National Cancer Institute. Cancer stat facts: Ovarian cancer. [Internet] 2016. [cited August 2019]. Available from https://seer.cancer.gov/statfacts/html/ovary.html   
  5. van de Vrie R, Rutten MJ, Asseler JD, et al. Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer. Cochrane Database Syst Rev. 2019; (3):CD009786. doi: 10.1002/14651858.CD009786.pub3. 
  6. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012; 62(1):10‐29. doi: 10.3322/caac.20138. 
  7. Ferlay J, Soerjomataram I, Ervik M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5):E359-386. doi: 10.1002/ijc.29210.
  8. Munkarah AR, Coleman RL. Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecol Oncol. 2004; 95(2):273‐280. 
  9. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for gynecologic conditions with pelvic examination: US Preventive Services Task Force recommendation statement. JAMA. 2017; 317(9):947-953. doi: 10.1001/jama.2017.0807.
  10. Moyer VA, U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012; 157(12):900-904. doi: 10.7326/0003-4819-157-11-201212040-00539.
  11. Barton M, Lin K. Screening for ovarian cancer: Evidence update for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Agency for Healthcare Research and Quality. 2012; AHRQ publication 12-05165-EF3.
  12. Canadian Task Force on Preventative Health Care. Ovarian cancer. [Internet] 2019. [cited August 2019]. Available https://canadiantaskforce.ca/guidelines/appraised-guidelines/ovarian-cancer/
  13. Canadian Cancer Society. Finding ovarian cancer early. [Internet] 2019. [cited August 2019]. Available from https://www.cancer.ca/en/cancer-information/cancer-type/ovarian/finding-cancer-early/?region=on 

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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