[Early detection and preoperative diagnosis of ovarian carcinoma]

Up to now no benefit of screening for ovarian cancer, using serum tumormarker and/or sonography has been proven. The following problems have to be taken into consideration: 1) With the low prevalence of ovarian cancer a screening test would require a 99.6% specificity to achieve a clinical acceptable positive predictive value of 10%. 2) Because sensitivity of the tumormarker in early stages is low (stage I 40 to 50%), mainly advanced stages are detected. 3) No efficient treatment for advanced stages, resulting in prolonged survival, exists. At the moment it is studied if women with high risk for ovarian cancer (familial cancer risk/syndrom, postmenopausal women) would benefit from tumormarker and/or sonography screening (higher prevalence leads to a higher positive predictive value). A major problem is that a surgical procedure is necessary to evaluate a (false) positive test result. At the moment there is no evidence that screening for ovarian cancer should be performed except within clinical studies. Especially in young women the use of CA 125 in the preoperative diagnosis of ovarian cysts is limited. In these women non-malignant gynecologic disorders causing unspecific tumormarker elevation (inflammation, endometriosis, myoma) are found more often. Therefore the diagnostic value of CA 125 is higher in postmenopausal women.