Ovarian cancer screening

Ovarian cancer fulfils some of the criteria necessary for the introduction of population screening: it is an important health problem, being the fourth most common cause of female cancer death in the UK, and early detection is associated with improved outcomes.1 Potential screening tests for ovarian cancer have not yet been shown to reduce mortality, although both ultrasound and tumour markers can detect a significant proportion of ovarian cancers pre-clinically and when used as sequential screening tools have been shown to extend median survival.2 Currently there is no national screening programme for ovarian cancer and evidence is pending from ongoing randomised controlled trials.

Section updated 08/03/11

A very large randomised controlled trial is currently being conducted in the UK which aims to recruit 200,000 post-menopausal women. The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) will assess the cost, acceptability and mortality benefit of population screening. Final results are expected in 2015. Women have been randomly assigned to three groups: no treatment (control group); annual multimodal screening (MMS; CA125 followed by transvaginal ultrasound as a second-line test); or annual ultrasound (UUS). Preliminary results from the prevalence screen of 100,000 women have recently been published.3 The results show that large scale population screening is feasible and does detect ovarian cancer in symptomless women. Both MMS and UUS detected ovarian cancers, half of which were at an early stage compared to around 28% in most clinical series. While sensitivity was similar between both screening arms, specificity was much higher in the MMS resulting in fewer false positives. As women enter the trial, blood samples are taken - this biobank of information will help in understanding the natural history of ovarian cancer and aid the search for better biomarkers for early detection.4 Algorithms are being developed which help to assess a woman’s risk of ovarian cancer using information in addition to the screening test results.

Section updated 08/03/11

Five thousand women aged over 35 with a significant family history of ovarian cancer are participating in the UK Familial Ovarian Cancer Screening Study (UKFOCSS), which assesses the utility of annual screening with CA125 measurement and ultrasound. In addition, blood samples are being collected every four months for retrospective analysis of existing and novel tumour markers.5

Section updated 08/03/11