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Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System

From the Southeast of Scotland Clinical Genetic Services, Western General Hospital; Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh; Ultrasound Department, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, Scotland; Academic Unit of Medical Genetics and Regional Genetics Service and Department of Radiology, St Mary's Hospital, Manchester; Wessex Clinical Genetic Services, Princess Anne Hospital, Southampton; University of St Andrews, Bute Medical Buildings, St Andrews; and Lothian Health Care NHS Trust, The Dean Terrace Centre, Edinburgh, United Kingdom

Address reprint requests to Diane Stirling, Macmillan Nurse Specialist in Genetics, Southeast of Scotland Clinical Genetic Services, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU Scotland; e-mail: diane.stirling{at}luht.scot.nhs.uk

PURPOSE: To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk.

PATIENTS AND METHODS: A cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease.

RESULTS: Thirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer.

CONCLUSION: Annual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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