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Screening for ovarian cancer

INTRODUCTION

Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. Approximately 21,980 cases are expected to be diagnosed in the United States in 2014 with an expected 14,270 deaths attributable to ovarian cancer [1]. The lifetime probability of a woman in the US developing ovarian cancer is less than 2 percent [2]. Worldwide in 2008, ovarian cancer was the seventh most common cancer in women, and incidence rates are highest in developed countries [3]. There were 225,500 new cases of ovarian cancer worldwide. The incidence of ovarian cancer increases with age; the highest proportion of cases are diagnosed in women 50 to 59 years of age.

Interest in early detection as a method of reducing mortality has grown with the discovery of serum tumor markers associated with ovarian malignancies (particularly CA 125) and with improved diagnostic accuracy of pelvic ultrasonography. Intensive research is ongoing to identify additional markers and a cost-effective screening strategy. One large-scale prospective clinical screening trial found that screening did not reduce mortality from ovarian cancer but did result in harm from consequent follow-up; two other large trials are in progress to determine whether screening by blood tests and/or ultrasound reduces mortality from ovarian cancer. (See 'Multimodal screening' below.)  

There is a consensus that women at average risk for ovarian cancer should NOT undergo screening. Despite evidence to the contrary, a cross-sectional survey of physicians in the US found that one in three believed that screening for ovarian cancer was effective and commonly offered testing [4].

Women with a family history of ovarian cancer or familial ovarian cancer syndromes are at higher risk of the disease. Evidence suggests screening is appropriate for some of these women. Screening recommendations for higher-risk women depend on whether or not there is a known or suspected hereditary cancer syndrome.

This topic will review the risks and benefits of screening for ovarian cancer in asymptomatic women. The issue of testing for ovarian cancer in women with nonspecific symptoms that may be associated with ovarian cancer is discussed separately. (See "Early detection of epithelial ovarian cancer: Role of symptom recognition".)

                         

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Literature review current through: Oct 2014. | This topic last updated: Oct 17, 2014.
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