USPSTF updates its ovarian cancer screening guidelines

The US Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer in asymptomatic women who are not at high-risk for ovarian cancer. This update is in consensus with its previous 2012 recommendations. The updated guidelines were published in recent issue of Journal of American Medical Association (JAMA).

USPSTF advise against screening for ovarian cancer in women who are asymptomatic and not at high-risk of hereditary cancer syndrome (D recommendation).

The presenting symptoms for ovarian cancer (bloating, constipation, abdominal pain or pressure, urinary symptoms, back pain, or fatigue) are nonspecific and may be present in both healthy women and women with late-stage ovarian cancer; therefore, these cannot be used to detect cancer at a very early stage.

This decision is based on benefits and harms of the screening test and cost was not considered in formulating the recommendations.

Ovarian cancer is the fifth in the list of cancer-specific mortality and tops the list of deaths due to gynecological malignancies, despite its low incidence of 11.4 cases per 100,000 women per year.

Many women who undergo screening for ovarian cancer receive false positive reports as the screening tests have low specificity.

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USPSTF has sufficient evidence to recommend that screening with transvaginal ultrasound, testing for the serum tumor marker cancer antigen 125 (CA-125), or a combination of both does not reduce ovarian cancer mortality.

Routine pelvic examination and bimanual palpation also do not help in early detection of cancer; furthermore, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial discontinued it as a screening test because not a single case was detected based only on bimanual pelvic examination.

The number of false -positive cases may result in unnecessary surgery and further testing for women who are cancer-free.

Women with hereditary cancer syndromes such as women with BRCA1 or BRCA2 genetic mutations should follow the specific recommendations and talk to their healthcare providers for guidance and cancer screening.

The recommendations are in agreement with the 2012 recommendations because the result of large UKCTOCS trial was published which in consensus with the PLCO trial, did not find sufficient evidence that screening for ovarian cancer reduces ovarian cancer mortality in asymptomatic women.

These recommendations are also in consensus with other major organizations like American College of Obstetricians and Gynecologists, American Cancer Society American College of Radiology and the American Academy of Family Physicians. 

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