Can Screening Reduce Mortality from Ovarian Cancer?
Andrew M. Kaunitz, MD reviewing Jacobs IJ et al. Lancet 2015 Dec 17.
Findings from massive U.K. trial show promise.
To determine whether screening is effective at reducing mortality from ovarian cancer, investigators in the U.K. randomized >200,000 postmenopausal women (age range, 50–74; mean age at baseline, 61) to no screening, annual transvaginal ultrasound screening (TVUS), or annual multimodal screening (MMS) with serum CA125 using the Risk of Ovarian Cancer Algorithm (ROCA), which takes into account temporal changes in CA125 levels. Women assessed as normal risk by ROCA criteria were advised to undergo repeat CA125 assessment in 1 year. Those assessed as intermediate risk were advised to repeat CA125 assessment in 3 months, and those assessed as high risk were advised to undergo TVUS in addition to repeat CA125 testing.
At a median follow-up of 11 years, ovarian cancer (including fallopian tube malignancies) was diagnosed in 1282 participants, with fatal outcomes in 0.34% of those in the no-screening group, 0.30% in the TVUS group, and 0.29% in the MMS group. In an analysis excluding prevalent cases of ovarian cancer, MMS was associated with an overall mortality reduction of 20% (P=0.021); this reduction rose from 8% during years 0 to 7 to 28% during years 7 to 14. Mortality reduction with TVUS was smaller than with MMS. The number needed to screen with MMS to prevent one death from ovarian cancer was 641. False-positive results (those leading to surgery demonstrating benign adnexal pathology or normal adnexa) occurred in 14 per 10,000 screens in the MMS group and 50 per 10,000 screens in the TVUS group. For each ovarian cancer detected in the MMS and TVUS groups, an additional 2 and 10 women, respectively, underwent surgery revealing false-positive screening.
Citation(s):
Jacobs IJ et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A randomised controlled trial. Lancet 2015 Dec 17; [e-pub].
