Screening for ovarian cancer
- Karen J Carlson, MD
Karen J Carlson, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Director, Gynecologic Oncology
- University of Washington Medical Center
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
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 . Worldwide, the number of new cases of ovarian cancer each year is approaching 250,000 . 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".)
BIOLOGICAL BASIS FOR SCREENING
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 . 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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- BIOLOGICAL BASIS FOR SCREENING
- FACTORS THAT AFFECT RISK
- RISKS AND BENEFITS OF SCREENING
- SCREENING TESTS
- Tumor markers
- - CA 125
- - Other tumor markers
- Ovarian cancer symptom index
- Pelvic ultrasonography
- Pelvic exam
- Multimodal screening
- - High-risk women
- SYNTHESIS OF THE EVIDENCE AND APPROACH TO SCREENING
- Women at average risk
- Women at increased risk
- - Lower-risk family history
- - High-risk family history
- RECOMMENDATIONS OF EXPERT GROUPS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS