Ovarian cancer screening rejected in Australian position statement

GU cancer

By Mardi Chapman

27 Feb 2019

There is currently no evidence to support the use of any test, or combination of tests, to screen for ovarian cancer in asymptomatic women at population risk of ovarian cancer or to monitor asymptomatic women at high or potentially high risk.

A Cancer Australia position statement Testing for ovarian cancer in asymptomatic women, has reiterated international guidance such as that from the US Preventive Services Task Force (USPSTF) reported in the limbic last year.

The USPSTF found currently available tests for ovarian cancer screening were not able to reduce mortality in average risk women and could instead do harm by causing healthy women to undergo surgery when no cancer was present.

The Australian document said neither serum CA-125 levels, transvaginal ultrasounds or combinations of those tests had been proven effective.

“A number of tests for ovarian cancer diagnosis or prognosis are under investigation; however, their potential for application as a screening tool is not yet known. DNA, plasma, serum and tissue samples from the large screening trials are being used to investigate new biomarkers, tests, and prediction models that may improve upon the Risk of Ovarian Cancer Algorithm (ROCA).”

“As there are currently no clinical trials of population screening for ovarian cancer in asymptomatic women, no new technologies are likely to be introduced or recommended for screening or surveillance in the short- to medium-term.”

“In light of the emerging understanding of the heterogeneity of ovarian cancers and early disease development, it is highly unlikely that a single biomarker or imaging modality will be sufficient to detect each of the various subtypes at their earliest stages.”

The position statement does however provide practice points for clinicians including the recommendation that referral for genetic assessment should be discussed with women who are at potentially high risk of ovarian cancer because of their family history.

It also said bilateral salpingo-oophorectomy was the most effective strategy for risk reduction in women at high risk of ovarian cancer.

The position statement has been endorsed by the Australian College of Rural and Remote Medicine, the Australian Society of Gynaecologic Oncologists, Cancer Council Australia, Ovarian Cancer Australia, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian and New Zealand College of Radiologists and the Royal College of Pathologists of Australasia.

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