Ovarian cancer screening in the general population

2019 ◽  
Vol 41 (3) ◽  
Author(s):  
Jérôme Mathis ◽  
Mohammed Amine Jellouli ◽  
Laura Sabiani ◽  
Joy Fest ◽  
Guillaume Blache ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Screening ◽  
General Population ◽  
Ultrasound Examination ◽  
Screening Method ◽  
Diagnostic Technique ◽  
Ca 125 ◽  
Ovarian Cancer Screening ◽  
Cancer Antigen ◽  
Diagnostic Management

AbstractBackgroundOvarian carcinoma is a poor prognosis cancer mainly due to its late diagnosis. Its incidence is relatively low but mortality is high. The symptomatology is only slightly specific, which complicates diagnostic management. It would therefore be interesting to be able to establish a diagnosis as early as possible in order to improve the prognosis of patients suffering from ovarian cancer.Materials and methodsCurrently, the combination of an ultrasound examination with a cancer antigen (CA)-125 assay is the most effective diagnostic technique, but not already admitted as a screening method. Therefore, we realized an exhaustive analysis of the most important studies in the last 15 years, in order to find new approaches in ovarian cancer screening.ResultsThe age for initiating screening and its frequency are issues that are not fully resolved. The false positives and morbidity that result from screening are currently notable limitations.ConclusionsThe latest data do not support effective screening in the general population.

scholarly journals Risk Algorithm Using Serial Biomarker Measurements Doubles the Number of Screen-Detected Cancers Compared With a Single-Threshold Rule in the United Kingdom Collaborative Trial of Ovarian Cancer Screening

2015 ◽  
Vol 33 (18) ◽  
pp. 2062-2071 ◽  
Author(s):  
Usha Menon ◽  
Andy Ryan ◽  
Jatinderpal Kalsi ◽  
Aleksandra Gentry-Maharaj ◽  
Anne Dawnay ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
United Kingdom ◽  
Cancer Screening ◽  
Ca 125 ◽  
Ovarian Cancer Screening ◽  
Collaborative Trial ◽  
The United Kingdom ◽  
Risk Algorithm ◽  
The Impact ◽  
Threshold Rule

Purpose Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates. Patients and Methods In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 46,237 women, age 50 years or older underwent incidence screening by using the multimodal strategy (MMS) in which annual serum cancer antigen 125 (CA-125) was interpreted with the risk of ovarian cancer algorithm (ROCA). Women were triaged by the ROCA: normal risk, returned to annual screening; intermediate risk, repeat CA-125; and elevated risk, repeat CA-125 and transvaginal ultrasound. Women with persistently increased risk were clinically evaluated. All participants were followed through national cancer and/or death registries. Performance characteristics of a single-threshold rule and the ROCA were compared by using receiver operating characteristic curves. Results After 296,911 women-years of annual incidence screening, 640 women underwent surgery. Of those, 133 had primary invasive epithelial ovarian or tubal cancers (iEOCs). In all, 22 interval iEOCs occurred within 1 year of screening, of which one was detected by ROCA but was managed conservatively after clinical assessment. The sensitivity and specificity of MMS for detection of iEOCs were 85.8% (95% CI, 79.3% to 90.9%) and 99.8% (95% CI, 99.8% to 99.8%), respectively, with 4.8 surgeries per iEOC. ROCA alone detected 87.1% (135 of 155) of the iEOCs. Using fixed CA-125 cutoffs at the last annual screen of more than 35, more than 30, and more than 22 U/mL would have identified 41.3% (64 of 155), 48.4% (75 of 155), and 66.5% (103 of 155), respectively. The area under the curve for ROCA (0.915) was significantly (P = .0027) higher than that for a single-threshold rule (0.869). Conclusion Screening by using ROCA doubled the number of screen-detected iEOCs compared with a fixed cutoff. In the context of cancer screening, reliance on predefined single-threshold rules may result in biomarkers of value being discarded.

Cost-effectiveness of ovarian cancer screening: An analysis of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) from a U.S. health system perspective.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6608-6608
Author(s):  
Haley Moss ◽  
Evan Myers ◽  
Andrew Berchuck ◽  
Laura Jean Havrilesky
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Sensitivity Analyses ◽  
Ca 125 ◽  
Mortality Reduction ◽  
Ovarian Cancer Screening ◽  
Risk Algorithm ◽  
The Us

6608 Background: UKCTOCS is the largest randomized controlled trial to evaluate screening’s impact on ovarian cancer mortality, assigning women to multimodal screening (MMS) with serum CA125 interpreted with a risk algorithm; annual transvaginal ultrasound; or no screening (NS). There was a non-statistically significant 15% reduction in mortality over 11 years in MMS group. As most of the potential benefit of screening was seen after 7 years, follow-up is ongoing to determine if an observed stage shift translates into significant mortality reduction. The current study estimates the cost-effectiveness of an MMS screening program in the US. Methods: A modified Markov model was constructed using data from UKCTOCS to compare MMS to NS. Published estimates of the long term effect of MMS screening on ovarian cancer mortality were used to simulate mortality over 40 years from the start of screening. Base case costs included CA125, ultrasounds, clinical evaluations and false-positive surgeries, with an annual weighted cost of $35 in addition to an estimated risk algorithm cost of $100. The utility and costs of ovarian cancer treatment were incorporated into the model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2016 U.S. dollars per quality-adjusted year of life saved (QALY). Additional sensitivity analyses were performed. Results: MMS is both more expensive and more effective in reducing ovarian cancer mortality over a lifetime than NS. Screening women from age 50 to 75 with MMS reduced mortality by 24% with an ICER of $98,062/QALY. If screening begins at age 60, MMS reduces mortality by 12%, with ICER below the willingness to pay threshold of $100,000/QALY only if the algorithm costs < $50. In probabilistic sensitivity analyses, the probability that screening from age 50-75 at an algorithm cost of $100 was less than $100,000/QALY was 41%. Conclusions: Ovarian cancer screening is potentially cost-effective in the US depending on final significance of mortality reduction and cost of the CA-125 risk algorithm. These results are limited by uncertainty around the effect of screening on ovarian cancer mortality beyond the 11 years of UKCTOCS.

scholarly journals Ovarian Cancer Screening Practices of Obstetricians and Gynecologists in Puerto Rico

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Gianni Rodríguez-Ayala ◽  
Josefina Romaguera ◽  
Mariel López ◽  
Ana P. Ortiz
Keyword(s):  
Ovarian Cancer ◽  
Puerto Rico ◽  
Cancer Screening ◽  
The United States ◽  
Ca 125 ◽  
Screening Methods ◽  
Health Practitioner ◽  
Average Risk ◽  
Ovarian Cancer Screening ◽  
Screening Practices

Background.Ovarian cancer is the most fatal malignancy of the female genital tract and is associated with high mortality. The American Congress of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) recommend against screening for ovarian cancer in asymptomatic, average-risk women.Objective.To assess the ovarian cancer screening practices in asymptomatic, average-risk women among obstetricians and gynecologists (Ob/Gyn) in Puerto Rico.Methodology.From 2011 to 2012, self-administered anonymous questionnaires were mailed to all licensed obstetricians and gynecologists in PR.Results.Response rate was 25%. Overall, 53.9% were screening for the disease. Reported screening methods were CA-125 and transvaginal ultrasound (TVUS), 39.2%, TVUS only, 30.4%, and CA-125 only, 9.8%. In the logistic regression model, the odds that a given health practitioner routinely screened for ovarian cancer in the asymptomatic, average-risk population increased by 8% with every unit increase in his or her years in practice.Conclusion.The majority of the practicing Ob/Gyn in PR who participated are not following the guidelines established by the ACOG and the USPSTF for ovarian cancer screening.

scholarly journals No evidence of excessive cancer screening in female noncarriers from BRCA1/2 mutation–positive families

2017 ◽  
Vol 24 (6) ◽  
pp. 352 ◽  
Author(s):  
S. Guedaoura ◽  
S. Pelletier ◽  
W.D. Foulkes ◽  
P. Hamet ◽  
J. Simard ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ovarian Cancer ◽  
Cancer Screening ◽  
Family History ◽  
General Population ◽  
Resonance Imaging ◽  
Breast And Ovarian Cancer ◽  
Ovarian Cancer Screening ◽  
Breast Ultrasonography ◽  
Screening Practices

Background In families with a proven BRCA1/2 mutation, women not carrying the familial mutation should follow the cancer screening recommendations applying to women in the general population. In the present study, we evaluated the cancer screening practices of unaffected noncarriers from families with a proven BRCA mutation, and we assessed the role of family history in their screening practices.Methods Self-report data were provided retrospectively by 220 unaffected female noncarriers for periods of up to 10 years (mean: 4.3 years) since disclosure of their BRCA1/2 genetic test result. A ratio for the annual frequency of breast and ovarian cancer screening exams (mammography, breast ultrasonography, breast magnetic resonance imaging, transvaginal or pelvic ultrasound, cancer antigen 125 testing) was calculated as number of screening exams divided by the number of years in the individual observation period.Results The annual average for mammography exams was 0.15, 0.4, 0.56, and 0.71 in women 30–39, 40–49, 50–59, and 60–69 years of age respectively. The uptake of other breast and ovarian cancer screening exams was very low. Mammography and breast ultrasonography and magnetic resonance imaging were generally more frequent among participants with at least 1 first-degree relative affected by breast cancer.Conclusions In most noncarriers, screening practices are consistent with the guidelines concerning women in the general population. When noncarriers adopt screening behaviours that are different from those that would be expected for average-risk women, those behaviours are influenced by their familial cancer history.Impact Decision tools might help female noncarriers to be involved in their follow-up in accordance with their genetic status and their family history, while taking into account the benefits and disadvantages of cancer screening.

Ovarian cancer screening.

1995 ◽  
Vol 13 (3) ◽  
pp. 783-793 ◽  
Author(s):  
S E Mackey ◽  
W T Creasman
Keyword(s):  
Ovarian Cancer ◽  
Large Scale ◽  
English Language ◽  
Color Doppler ◽  
Screening Method ◽  
Screening Tools ◽  
Doppler Imaging ◽  
Ca 125 ◽  
Ovarian Cancer Screening ◽  
Long Term Study

PURPOSE To review potential screening tools of early ovarian cancer and the associated risk factors for the development of ovarian carcinoma. DESIGN AND RESULTS A review of pertinent literature was conducted, restricted to English-language published reports, book chapters, and articles. The value of serum tumor markers, particularly CA 125, ultrasound, transabdominal and transvaginal ultrasonography, and transvaginal color Doppler imaging as screening tools for ovarian cancer was assessed. CONCLUSION Based on the literature, a large-scale long-term study that compares the mortality rates of a screened versus unscreened patient population is required before the efficacy of any screening method can be determined definitively.

Sign in / Sign up

Export Citation Format

Share Document