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Screening for ovarian carcinoma: hopeful and wishful thinking
1Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill 27599-7570.
Objective:
The purpose of this study was to review the published articles on screening for ovarian carcinoma.
Study Design:
A retrospective review was performed of the articles published in the English literature during the past 10 years. The articles of Herbst and Cohen, included in this panel discussion, were reviewed as part of this study.
Results:
Compared with the prevalence of other cancers screened for by gynecologists, that of ovarian cancer is low. Neither CA 125 nor vaginal ultrasonography has consistently provided the mandatory high specificity and sensitivity values required for successful screening of a disease of low prevalence. The cost of vaginal ultrasonography and color flow Doppler studies is too high for mass screening programs.
Conclusion:
There is little evidence to support widespread screening of large populations of women who do not have familial or genetic risk factors for ovarian carcinoma. An informed patient and an informed physician should weigh the risk-benefit ratios of periodic screening versus prophylactic oophorectomy in the individual high-risk patient. The effectiveness of periodic screening has not been established or proved even for the high-risk patient.