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Screening for ovarian cancer

Karen J Carlson, MD
Section Editors
Barbara Goff, MD
Joann G Elmore, MD, MPH
Deputy Editor
Judith A Melin, MA, MD, FACP


Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. In the United States each year, there are approximately 22,000 new cases of ovarian cancer and 14,000 cancer-related deaths [1]. Worldwide, the number of new cases of ovarian cancer each year is approaching 250,000 [2]. It is the seventh most common cancer in women, and incidence rates are highest in developed countries. The incidence of ovarian cancer increases with age. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Epidemiology and risk factors".)

Interest in early detection as a method of reducing mortality developed with the discovery of serum tumor markers associated with ovarian malignancies (particularly CA 125) and with the improved diagnostic accuracy of pelvic ultrasonography. 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".)

Additionally, screening in women at high risk of ovarian cancer, the clinical manifestations of epithelial ovarian cancer, epidemiology and risk factors for ovarian cancer, and surveillance for patients who have been treated for ovarian cancer are discussed separately. (See "Management of patients at high risk for breast and ovarian cancer" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Histopathology" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Epidemiology and risk factors".)


Survival from ovarian cancer is related to the stage at diagnosis; five-year survival is over 90 percent for the minority of women with stage I disease [3]. This number drops to about 75 to 80 percent for regional disease and 25 percent for those with distant metastases.

Despite the good prognosis associated with early-stage disease, overall five-year survival in women with ovarian cancer is less than 45 percent. This poor survival rate in large part is due to the spread of cancer beyond the ovary at the time of clinical detection in 75 percent of patients. Mortality from ovarian cancer has decreased only slightly in the past 30 years [3].

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Literature review current through: Dec 2017. | This topic last updated: Sep 05, 2017.
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  1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  2. World cancer research fund international. Cancer facts and figures. http://www.wcrf.org/int/cancer-facts-figures/worldwide-data (Accessed on April 17, 2017).
  3. Barnholtz-Sloan JS, Schwartz AG, Qureshi F, et al. Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades. Am J Obstet Gynecol 2003; 189:1120.
  4. Tobacman JK, Greene MH, Tucker MA, et al. Intra-abdominal carcinomatosis after prophylactic oophorectomy in ovarian-cancer-prone families. Lancet 1982; 2:795.
  5. Kurman RJ, Visvanathan K, Roden R, et al. Early detection and treatment of ovarian cancer: shifting from early stage to minimal volume of disease based on a new model of carcinogenesis. Am J Obstet Gynecol 2008; 198:351.
  6. Kerlikowske K, Brown JS, Grady DG. Should women with familial ovarian cancer undergo prophylactic oophorectomy? Obstet Gynecol 1992; 80:700.
  7. Weitzel JN, Lagos VI, Cullinane CA, et al. Limited family structure and BRCA gene mutation status in single cases of breast cancer. JAMA 2007; 297:2587.
  8. Jacobs I. Genetic, biochemical, and multimodal approaches to screening for ovarian cancer. Gynecol Oncol 1994; 55:S22.
  9. Rosenthal AN, Menon U, Jacobs IJ. Screening for ovarian cancer. Clin Obstet Gynecol 2006; 49:433.
  10. Moore RG, MacLaughlan S, Bast RC Jr. Current state of biomarker development for clinical application in epithelial ovarian cancer. Gynecol Oncol 2010; 116:240.
  11. Pickhardt PJ, Hanson ME. Incidental adnexal masses detected at low-dose unenhanced CT in asymptomatic women age 50 and older: implications for clinical management and ovarian cancer screening. Radiology 2010; 257:144.
  12. Carlson KJ, Skates SJ, Singer DE. Screening for ovarian cancer. Ann Intern Med 1994; 121:124.
  13. Bast RC Jr, Klug TL, St John E, et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med 1983; 309:883.
  14. Mol BW, Bayram N, Lijmer JG, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril 1998; 70:1101.
  15. Zuckerman E, Lanir A, Sabo E, et al. Cancer antigen 125: a sensitive marker of ascites in patients with liver cirrhosis. Am J Gastroenterol 1999; 94:1613.
  16. Devarbhavi H, Kaese D, Williams AW, et al. Cancer antigen 125 in patients with chronic liver disease. Mayo Clin Proc 2002; 77:538.
  17. Sjövall K, Nilsson B, Einhorn N. The significance of serum CA 125 elevation in malignant and nonmalignant diseases. Gynecol Oncol 2002; 85:175.
  18. Topalak O, Saygili U, Soyturk M, et al. Serum, pleural effusion, and ascites CA-125 levels in ovarian cancer and nonovarian benign and malignant diseases: a comparative study. Gynecol Oncol 2002; 85:108.
  19. Johnson CC, Kessel B, Riley TL, et al. The epidemiology of CA-125 in women without evidence of ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. Gynecol Oncol 2008; 110:383.
  20. Jacobs IJ, Skates S, Davies AP, et al. Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: a prospective cohort study. BMJ 1996; 313:1355.
  21. Zurawski VR Jr, Orjaseter H, Andersen A, Jellum E. Elevated serum CA 125 levels prior to diagnosis of ovarian neoplasia: relevance for early detection of ovarian cancer. Int J Cancer 1988; 42:677.
  22. Einhorn N, Sjövall K, Knapp RC, et al. Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer. Obstet Gynecol 1992; 80:14.
  23. Jacobs I, Davies AP, Bridges J, et al. Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 1993; 306:1030.
  24. Prorok PC, Andriole GL, Bresalier RS, et al. Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials 2000; 21:273S.
  25. Buys SS, Partridge E, Greene MH, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 2005; 193:1630.
  26. Partridge E, Kreimer AR, Greenlee RT, et al. Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol 2009; 113:775.
  27. Skates SJ, Menon U, MacDonald N, et al. Calculation of the risk of ovarian cancer from serial CA-125 values for preclinical detection in postmenopausal women. J Clin Oncol 2003; 21:206s.
  28. Menon U, Skates SJ, Lewis S, et al. Prospective study using the risk of ovarian cancer algorithm to screen for ovarian cancer. J Clin Oncol 2005; 23:7919.
  29. Clarke-Pearson DL. Clinical practice. Screening for ovarian cancer. N Engl J Med 2009; 361:170.
  30. Shah CA, Lowe KA, Paley P, et al. Influence of ovarian cancer risk status on the diagnostic performance of the serum biomarkers mesothelin, HE4, and CA125. Cancer Epidemiol Biomarkers Prev 2009; 18:1365.
  31. Moore RG, McMeekin DS, Brown AK, et al. A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol 2009; 112:40.
  32. Yurkovetsky Z, Skates S, Lomakin A, et al. Development of a multimarker assay for early detection of ovarian cancer. J Clin Oncol 2010; 28:2159.
  33. Anderson GL, McIntosh M, Wu L, et al. Assessing lead time of selected ovarian cancer biomarkers: a nested case-control study. J Natl Cancer Inst 2010; 102:26.
  34. Moore LE, Pfeiffer RM, Zhang Z, et al. Proteomic biomarkers in combination with CA 125 for detection of epithelial ovarian cancer using prediagnostic serum samples from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cancer 2012; 118:91.
  35. Urban N, Hawley S, Janes H, et al. Identifying post-menopausal women at elevated risk for epithelial ovarian cancer. Gynecol Oncol 2015; 139:253.
  36. Andersen MR, Goff BA, Lowe KA, et al. Combining a symptoms index with CA 125 to improve detection of ovarian cancer. Cancer 2008; 113:484.
  37. Rossing MA, Wicklund KG, Cushing-Haugen KL, Weiss NS. Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst 2010; 102:222.
  38. Andersen MR, Goff BA, Lowe KA, et al. Use of a Symptom Index, CA125, and HE4 to predict ovarian cancer. Gynecol Oncol 2010; 116:378.
  39. Pavlik EJ, DePriest PD, Gallion HH, et al. Ovarian volume related to age. Gynecol Oncol 2000; 77:410.
  40. Bourne TH, Campbell S, Reynolds KM, et al. Screening for early familial ovarian cancer with transvaginal ultrasonography and colour blood flow imaging. BMJ 1993; 306:1025.
  41. Karlan BY, Raffel LJ, Crvenkovic G, et al. A multidisciplinary approach to the early detection of ovarian carcinoma: rationale, protocol design, and early results. Am J Obstet Gynecol 1993; 169:494.
  42. van Nagell JR Jr, Miller RW, DeSimone CP, et al. Long-term survival of women with epithelial ovarian cancer detected by ultrasonographic screening. Obstet Gynecol 2011; 118:1212.
  43. Menon U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10:327.
  44. Jacobs IJ, Menon U, Ryan A, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2016; 387:945.
  45. Fishman DA, Cohen L, Blank SV, et al. The role of ultrasound evaluation in the detection of early-stage epithelial ovarian cancer. Am J Obstet Gynecol 2005; 192:1214.
  46. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for Gynecologic Conditions With Pelvic Examination: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 317:947.
  47. Smith LH, Oi RH. Detection of malignant ovarian neoplasms: a review of the literature. III. Immunological detection and ovarian cancer-associated antigens. Obstet Gynecol Surv 1984; 39:346.
  48. Bloomfield HE, Olson A, Greer N, et al. Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med 2014; 161:46.
  49. Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 2011; 305:2295.
  50. Jacobs IJ, Skates SJ, MacDonald N, et al. Screening for ovarian cancer: a pilot randomised controlled trial. Lancet 1999; 353:1207.
  51. Kobayashi H, Yamada Y, Sado T, et al. A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 2008; 18:414.
  52. Rosenthal AN, Fraser L, Manchanda R, et al. Results of annual screening in phase I of the United Kingdom familial ovarian cancer screening study highlight the need for strict adherence to screening schedule. J Clin Oncol 2013; 31:49.
  53. Hermsen BB, Olivier RI, Verheijen RH, et al. No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study. Br J Cancer 2007; 96:1335.
  54. Lacey JV Jr, Greene MH, Buys SS, et al. Ovarian cancer screening in women with a family history of breast or ovarian cancer. Obstet Gynecol 2006; 108:1176.
  55. Urban N, Drescher C, Etzioni R, Colby C. Use of a stochastic simulation model to identify an efficient protocol for ovarian cancer screening. Control Clin Trials 1997; 18:251.
  56. Havrilesky LJ, Sanders GD, Kulasingam S, Myers ER. Reducing ovarian cancer mortality through screening: Is it possible, and can we afford it? Gynecol Oncol 2008; 111:179.
  57. www.cancer.gov/cancertopics/pdq/screening/ovarian/healthprofessional/allpages (Accessed on August 24, 2009).
  58. Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet 2014; 384:1376.
  59. http://www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarartaddend.htm (Accessed on June 26, 2012).
  60. Moyer VA, U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2012; 157:900.
  61. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement174/ovarian-cancer-screening1#Pod4 (Accessed on August 27, 2017).
  62. https://www.sgo.org/choosing-wisely/ (Accessed on February 11, 2017).
  63. https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/The_Role_of_the_Obstetrician_Gynecologist_in_the_Early_Detection_of_Epithelial_Ovarian_Cancer (Accessed on February 20, 2014).
  64. Screening for Ovarian Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. US Preventive Services Task Force 2013. http://canadiantaskforce.ca/guidelines/appraised-guidelines/ovarian-cancer/ (Accessed on February 11, 2017).
  65. Population screening and early detection of ovarian cancer in asymptomatic women. Cancer Australia 2009. https://canceraustralia.gov.au/publications-and-resources/position-statements/population-screening-and-early-detection-ovarian-cancer-asymptomatic-women (Accessed on February 11, 2017).