Early detection and screening for ovarian cancer

Ovarian cancer is associated with postmenopausal women of North American or European descent, nulliparous women, and women with a first-degree relative with an epithelial ovarian cancer. Methods for early detection of ovarian cancer are the pelvic examination, ultrasound techniques, and CA-125 monitoring, none of which are highly sensitive or specific for the disease. At the Yale-New Haven Medical Center, first-degree relatives of women with epithelial ovarian cancer were invited to participate in an intense ovarian cancer screening program consisting of tumor markers, endovaginal ultrasound and color Doppler flow studies, and physical examinations performed in a serial fashion. The false-positive rate for the tumor markers varied from 2 to 9% at initial evaluation of the first 247 participants. Endovaginal ultrasound and color Doppler flow techniques were used to evaluate 326 ovaries in 169 women. Resistive indices < 0.5 were present in 26 ovaries (8.4%), and peak systolic velocities > 30 cm/sec occurred in 7 ovaries (2.3%). To date, four breast cancers have been detected, three cervical intraepithelial neoplasias have been identified, and three atypical adenomatous hyperplasias were diagnosed. No epithelial ovarian cancer was found. Isolated screening for ovarian cancer even in high-risk women is not cost effective. Women screened for ovarian cancer should also be evaluated for cancers of the breast, cervix, colon, rectum and endometrium. Isolated abnormal screening test values are not an indication for surgery.