Evolution of screening for epithelial ovarian carcinoma: the quest for early diagnosis

Epithelial ovarian carcinoma remains the most fatal of gynecologic malignancies, causing approximately 13,300 deaths annually. This high mortality rate is due to the presence of advanced stage disease at time of diagnosis. Symptoms early in the course of the disease are frequently nonspecific and go unrecognized by both the patient and the physician. The cause-specific mortality may decrease if a sufficiently sensitive screening modality can be developed to allow early diagnosis and curative therapy. The ideal screening tests or algorithm utilizing several tests must have sufficient specificity to minimize false positives, which contribute to patient anxiety and inefficient use of health care dollars. The development and refinement of the various methodologies used in screening of epithelial ovarian carcinoma will be the subject of this review.