Still no screening test for ovarian cancer

Latest trial of two screening procedures fail to reduce mortality

Ovarian cancer remains a major cause of death in women because it is often detected late in the course of the disease and treatment is unable to have any significant effect. This has led medical researchers to look for ways, such as blood tests or imaging, to screen women for ovarian cancer when they have no symptoms and detect it much earlier. Screening is used for cervical cancer (the HPV test) and breast cancer (imaging) with considerable success.  Now, the results are in of a large trial conducted across UK hospitals which looked at two ways to screen for ovarian cancer.

More than 200,000 healthy women without any previous history of cancer were involved in the study and were randomly allocated to one of three groups.

Women in the first group were screened using a combination of the CA-125 blood test which is used routinely to monitor patients during their cancer treatment, together with a transvaginal ultrasound. The second group were screened using only transvaginal ultrasound. In both groups the tests were done on an annual basis over 15 years. The third group of women did not undergo any screening procedure and received what is currently normal care.

In a similar way to other cancers, ovarian cancer is described according to the stage of the disease at the time of diagnosis. Stage 1 is early disease while Stage 4 is the most advanced.  The results of the trial showed that the screening procedure using the combination of the CA-125 test and ultrasound led to a significant increase in the diagnosis of Stage 1 disease as compared to the women in the no screening group. The same screening procedure also led to a decrease in the number of women diagnosed with more severe (Stages 3 & 4) disease compared to the women who received no screening.

But disappointingly, despite these positive findings of reductions in the incidence of severe disease in one of the screening groups, it did not lead to fewer women dying in either of the two screening groups compared to the no screening group – the rate of death was similar in all three groups.

These findings highlight the importance of carrying out trials like this over long periods so that their potential impact can be fully assessed. But of course the main conclusion is that general population screening for ovarian cancer cannot be conducted until we find a way to detect the disease earlier in women who have no symptoms of the disease.

Menon U et al.  Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet May 12, 2021.

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