Monday, April 16, 2012

I Agree with the USPSTF

The US Preventative Services Task Force is updating its Screening for Ovarian Cancer document. See the complete document here. The recommendation follows.

" The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer. 
Grade: D Recommendation.

D—Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits." 

They have posted a great info sheet so women can better understand the conclusion they have reached.

The Task Force does not believe that the general population should receive a routine CA-125 blood test or an ultrasound( transabdominal or transvaginal) as screening for ovarian cancer.

Why did they make this recommendation?

  • Routine screening with CA-125 and Ultrasound does not reduce deaths from Ovarian Cancer
  • The task force is moderately certain that harms from screening ( surgery etc) outweigh the benefits

NOTE: The recommendation does not apply to those at risk- women with BRCA mutations or women with a history of ovarian cancer in their  family.

The decision to not recommend screening asymptomatic women was not made in a void. The document is based on the results of large studies.

  1. The Prostate Lung colorectal and Ovarian Cancer Screening trial had 78,000 participants. (I wrote about this trial last June after hearing results at the ASCO meeting. )There was no difference between the stage of diagnosis or number of deaths from ovarian cancer in the screened group vs the non-screened group.    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(22):2295-303.
  2. The ongoing UK Collaborative Trial of Ovarian Cancer Screening preliminary results show that l ess than 1% of the women had surgery after the screening process. Of the 16 women who underwent surgery , 11 had false positives ( no cancer was found) . There were a number of women who had complications from the surgery . 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(4):327-40.

One thing I learned last year as a Focus on Research Scholar was that a biomarker/ screening test must be specific and sensitive. The CA-125 is not specific ( it can be high from other cancers and gastrointestinal illnesses) nor is it sensitive enough that the cancer may be detected in early  stages.  

This article by Dr Otis Brawley discusses the recommendation and  why we need a screening test for ovarian cancer.

I know many women will not agree with this recommendation but as a scientist and a survivor whose CA-125 was normal on recurrence , I agree with the conclusion drawn by this Task Force.

Now let us get to work and fund the research to find a better, specific and sensitive screening test for Ovarian Cancer!


 Every Day is a Blessing!

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