Ovarian Cancer Screening:
Concepts and Controversies
Recently, the Food and Drug Administration issued a rare public health warning against ovarian cancer screening. To many people, this may seem confusing or contradictory. One might pose the following questions: Is it not the FDA’s job to protect the public against health threats? Is not ovarian cancer a lethal disease which kills thousands of American women each year? Why would the FDA issue such a disheartening message?
As an experienced gynecologic oncologist, hundreds of patients and family members have asked me over the years: “Why are most ovarian cancers diagnosed at such a late stage when it cannot be surgically cured?”
Ovarian cancer is a rare but very serious disease. In the United States, there are about 22,500 new cases each year. There are approximately 14,500 deaths each year from ovarian cancer in the US. The fundamental purpose of cancer screening tests (such as mammograms for breast cancer, pap smears for cervix cancer, and colonoscopy for colon/rectal cancer) is to lower the death rate from that cancer in the general population by catching the cancer before it grows and spreads.
Pap smears have proven to be one of the most effective public health screening tests in human history. In the developed world, death rates from cervix cancer (once a very common female cancer that killed tens of thousands of American women) have fallen by 75% over the past 75 years since physicians began screening for cervix cancer. Cervix cancer and deaths from cervix cancer are now very rare in the US due to widespread cervical cancer screening programs.
The “scientific proof” that screening the general population for ovarian cancer lowers death rates from this disease has been elusive. The main reason for this is that ovarian cancer is uncommon in the general population. Screening the general population for a rare disease has a distinct “down side.” The cancer screening test can falsely identify people as having a disease when they truly do not. These “false positive” screening results can lead individuals down a path toward unnecessary interventions and risks.
In 2011, the results of a large study of ovarian cancer screening here in the US were published. This study revealed that screening for ovarian cancer using blood tests and sonograms in the general population was not effective at saving lives.
Nine months ago, the initial results of a very important ovarian cancer screening study were published by Dr. Ian Jacobs and his team from the United Kingdom. This trial (called UKCTOCS) which began in 2001, involved over 200,000 women screened regularly over time for ovarian cancer using blood tests, sonograms, and physical examinations. The FDA and many other experts feel strongly that the results of the recently published UK trial do not prove that ovarian cancer screening is effective at saving lives.
For this reason, each woman should know the symptoms of ovarian cancer and be on the lookout for any of them in her body. These include persistent abdominal bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and/or urinary urgency or frequency. If you have suspicious symptoms lasting more than two to three weeks, talk to your doctor. This is the best chance for early detection.
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