Can we screen for ovarian cancer?

Objectives:

To assess the efficacy of annual CA125 and transvaginal ultrasound (TVU) scan as surveillance for ovarian cancer.

Design:

Retrospective audit.

Setting:

NHS Trust. POPULATION: Three hundred and forty-one asymptomatic women enrolled for ovarian cancer screening: 179 were in a high-risk group (>10% lifetime risk of developing ovarian cancer), 77 in a moderate risk group (4-10% lifetime risk of developing ovarian cancer) and 71 in a near population risk group (<4% lifetime risk).

Methods:

Retrospective audit of case records, laboratory CA125 results, radiology reports, histology records and local cancer registry data.

Main Outcome Measures:

Ovarian cancers occurring in study population. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU, and CA125 as a screening tool for ovarian cancer.

Results:

Four ovarian cancers and one endometrial cancer occurred. One ovarian cancer was detected at surveillance, three occurred in women who presented symptomatically between screenings. Thirty women underwent exploratory surgery because of abnormal findings at surveillance. Two women had cancer (PPV = 6.7%); one had ovarian cancer and the other endometrial cancer. Twenty-eight women (93.3%) had no malignancy. Sensitivity, specificity, PPV and NPV for TVU in the whole cohort were 33.3, 85.8, 0.6 and 99.8%, respectively. For high-risk individuals, the figures for TVU were 33.3, 84.5, 1.1 and 99.6, respectively. Combining both modalities for the whole cohort, the sensitivity, specificity, PPV and NPV were 66.7, 82.9, 1.5 and 99.8% and 50.0, 82.8, 1.3 and 99.7%, respectively, for the high-risk group alone.

Conclusions:

Ovarian screening by annual TVU and CA125 is inefficient at detecting early-stage ovarian cancers.

Please click on the required question.

• 1 What is cancer (malignancy)
• 2 What is meant by cancer staging?
• 3 How prevalent is cancer?
• 4 How prevalent are womens' cancers?
• 5 What causes cancer?
• 6 Is cancer a hereditary condition?
• 7 How can gynaecological cancer present?
• 8 How can we reduce the risks of the womens' cancers?

   

  Reducing the Risks of Womens' Cancers.

• 9 What are screening tests?
• 10 What are the reactions to a diagnosis of cancer?
• 11 Is there a place for counselling when cancer is diagnosed?
• 12 Can personality alter the prognosis?
• 13 Is the incidence of deaths from the female cancers changing?
• 14 Is there a place for a holistic approach to cancer?

   

  Cancer of the Cervix.

• 15 How prevalent is cervical cancer?
• 16 What causes cervical cancer?
• 17 How long an interval should there be between cervical screening (smear) (PAP) tests?
• 18 Is there any evidence that cervical screening can reduce the incidence of cervical cancer?
• 19 Will pre-malignant changes of the cervix invariably lead to cancer?

   

  Endometrial Cancer (Uterus)

• 20 What causes endometrial cancer?
• 21 Are there screening tests for endometrial cancer?
• 22 How does endometrial cancer present?
• 22a How can endometrial cancer be prevented?
• 22b How can endometrial cancer be treated?

  Cancer of the Ovary.

• 23 How does ovarian cancer present?
• 24 How prevalent is ovarian cancer?
• 25 What are tumour markers?
• 26 Can we screen for ovarian cancer?
• 27 What is the relationship between infertility and ovarian cancer?
• 28 Can treatment of infertility increase the risk of ovarian cancer?
• 29 What is the relationship between oral contraception and cancer?
• 30 Can ovarian cancer be prevented?
• 31 I use talcum power. Could this increase my risk of developing ovarian cancer?

   

  The Treatment Of Womens' Cancers

• 32 Can we predict the course of a cancer?
• 33 What treatment options are available for gynaecological cancer?
• Q32.33c What treatment options are available for ovarian cancer?

  Cancer of the Vulva, Vagina and Fallopian Tube

• 34 How prevalent are malignant conditions of the vulva, vagina and Fallopian tubes?

  Breast Cancer

• 35 What is the incidence of breast cancer?
• 35 ?What is the cause of breast cancer?
• 35a What are the advantages of breast cancer screening - mammography - mammograms?
• 36 How often should breast screening be carried out?
• 37 Are there any problems having a mammogram?
• 38 Should I check myself for breast lumps?
• 39 One of my family developed cancer of the breast. Am I at increased risk?
• 40 We have a family tendency towards developing breast / ovarian cancer. Are there any genetic tests to find out if I am at increased risk?
• 41 What happens if a mammogram shows an abnormality?
• 42 What are the advantages and disadvantages of tamoxifen in the management of breast cancer?
• 42a Breast Cancer Treatment - What is available?
• 43 What is the relationship between breast cancer and the pill?

  Web sites and Support Groups

• 44 Are there any support groups?
• 44 Are there any support groups?
• 45 Support Groups.
• 46 Breast Cancer Support Groups
• 47 Ovarian Cancer Support Groups
• 48 Endometrial Cancer Support Groups
• 49 Cervical Cancer Support Groups
  
  
  

  
  
  

  Thank you for choosing to visit us.

  
  

  This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

  I do hope that you find the answers to your women's health questions in the patient information and medical advice provided. If you still have unanswered questions, please consider entering them into one of our forums and I will try to assist you.