Monday, May 27, 2013

Ovarian Cancer Screening

Here is a real case study from American Family Physician with the correct "answers" that may surprise women (and men).  It is a common case in my practice too as more and more women are health conscious and want to do everything possible to detect early cancer.


A 35 year old woman presents for a routine well-woman exam.  She is worried about ovarian cancer because one of her friends was recently diagnosed.  She has no family history of breast, ovarian or colon cancer.  What do you do?

Answer:  Based on U.S. Preventive Services Task Force recommendation on screening for ovarian cancer, you advise against screening tests because they do not have good sensitivity for cancer and there are too many false-positive results.  The screening tests like Ca125 and transvaginal ultrasound have not been shown to reduce the number of ovarian cancer deaths.

Keep in mind that these recommendations do not apply to the following women.  Studies show these woman would benefit from those screening tests:
  • A woman with a confirmed BRCA1 genetic mutation
  • A woman with multiple family members who have had colon cancer (Lynch Syndrome)
  • A woman whose mother, sister or grandmother had ovarian cancer and breast cancer also in the close family
  • An Ashkenazi Jewish woman with close family members with breast or ovarian cancer.
I know being advised NOT to undergo a screening test is hard to understand.  Most patients believe if there is a test that could remotely pick up an early cancer, they want to have it.  Unfortunately we just don't have good tests for ovarian cancer.  False positive tests usually lead to removal of an ovary and the harm outweighs the good.   Perhaps in the future we will have genetic biomarkers that will help detect cancer.  Right now we don't.


Anonymous said...

Love your column, always read it! Okay, so now let us know what we should do. Are you suggesting anything else in terms of screening? The vague guidelines now about bloating, increased flatulence, etc. are part of parcel of the vagaries of a female body. How does the Average Jane differentiate, and if it seems warranted, get help? Thanks in advance. Barb

Toni Brayer, MD said...

Hi Barb,
You are correct that the "warning signs" that are mentioned for ovarian cancer are vague and common. Certainly increasing abdominal pain, nausea and widening tummy are symptoms but by that time it is often too late. I wish I could say that we have adequate screening for early detection but we don't. Other cancers are equally difficult to catch early: brain, pancreas,and certain sarcomas. No good news here. Evey day is a gift and one should live as healthily as possible and not worry about what cannot be changed.

Not very scientific but true.

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