The USPSTF maintains its recommendation against screening for ovarian cancer in average risk women

The U.S. Preventive Services Task Force today released a draft recommendation statement and evidence review on ovarian cancer screening that is in line with its final recommendation in 2012.

The USPSTF has given a ‘D’ grade for screening recommendation for ovarian cancer in asymptomatic women, that means “The USPSTF recommends against screening for ovarian cancer in asymptomatic women.”

The USPSTF found adequate evidence that screening with transvaginal ultrasound, testing for the serum tumor marker cancer antigen (CA)–125, or a combination of both does not reduce the number of deaths from ovarian cancer in women.

The current evidence was insufficient to assess the balance of benefits and harms of performing screening pelvic examination in asymptomatic, nonpregnant adult women.

The screening tests also have a low positive predictive value, which means that most women who receive a positive diagnosis of ovarian cancer do not have one.

It also leads to unnecessary surgery and psychological harm.

This screening guidelines are not for women with BRCA 1 and BRCA2 mutation, Lynch, Li-Fraumeni, or Peutz-Jeghers syndrome. Women with BRCA1 and BRCA2 mutations have an average risk of 44% and 17% for developing ovarian cancer. Mutations in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers.

USPSTF also does not advice routine screening in women with family history breast and ovarian cancer, as a higher incidence of cancer incidence in family may results in greater number of patients diagnosed with ovarian cancer but it does not necessary translate into saving lives.

These women can be referred  for genetic counseling and, if indicated, genetic testing.

USPSTF chair David Grossman, MD, MPH, senior investigator at Kaiser Permanente Washington Health Research Institute, said in a statement, “The current screening tests do not do a good job of identifying whether a woman does or does not have ovarian cancer. The Task Force hopes that in the future, better screening tests for ovarian cancer will be developed.”

The draft recommendation was supported by results of two large clinical trials United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial which both showed that screening for ovarian cancer does not decrease deaths from ovarian cancer in asymptomatic women not known to be at high risk for ovarian cancer.

The recent draft recommendation is in consensus with guidelines issued by other major medical and public health organizations like American College of Obstetricians and Gynecologists, American Cancer Society, American College of Radiology and American Academy of Family Physicians.

The draft recommendation statement is open to public comments till August 14, 2017.

The full text of the recommendations can be accessed here.