Should you get screened for ovarian cancer?

For many women, by the time ovarian cancer symptoms appear, the disease has spread. Late detection will contribute to more than 14,000 women losing their lives this year, and fewer than half will survive five years after diagnosis.

As a gynecologic oncology division director, I treat many patients for ovarian cancer, but far too many women end up dying of their disease. This statistic is a heavy burden for those of us entrusted with their care, and argues for the need to do more to prevent and detect ovarian cancer.

{mosads}Does that mean I recommend all women get screened for ovarian cancer? The answer is no.

Unless you are experiencing symptoms or have an elevated risk, then the potential harm from screening will likely outweigh the benefits — though it’s not a decision to make lightly. New evidence is emerging that can help you and your doctor evaluate your best options.

In search of a rare disease

Ovarian cancer is exceptionally rare. In fact, it comprises only about three percent of the cancer cases diagnosed in American women.

While options for screening are fairly accurate and without medical risk (tests currently involve a blood test for a cancer marker called CA125 and a pelvic ultrasound), the major risk from screening comes from the rate of false positive tests (a screen that is positive when there is no cancer), which then lead to unnecessary surgery to remove the uterus and ovaries.

In addition to added cost — and the dangers present with any major surgical procedure — that outcome can bring psychological harm, including those resulting infertility and menopause.

If all women were screened, the number of those harmed would be too high relative to the number of women whose lives might be saved by identifying early disease when it would be curable.

Evaluating the risks

That aligns with recent guidance from the U.S. Preventive Services Task Force (USPSTF), a panel of expert advisors who weigh evidence for and against preventive medicine.

Their latest draft recommendation for ovarian cancer was just released, and for women with no symptoms and at no increased risk for ovarian cancer, they advise against screening and give their lowest grade, D.

This grade was the same as their last recommendation in 2012, and was bolstered by a 14-year study of more than 200,000 women in the United Kingdom that suggested screening of asymptomatic women at normal risk does not significantly reduce ovarian cancer mortality.

Other organizations have come to same conclusion, including the American College of Obstetricians and Gynecologists and the American Cancer Society.

However, there remains an important caveat: For patients presenting ovarian cancer symptoms or who have an increased risk of the disease — such as a genetic predisposition to ovarian cancer such as a BRCA gene mutation — screening or early detection may be the right choice.

Recognizing the threat

A physician’s advice is key, as the symptoms for ovarian cancer—abdominal pain, nausea, problems with urination frequency or urgency, or problems with bowel movements—can be difficult to distinguish from those of more common diseases. If you or a loved one is having any of those symptoms, a doctor’s visit is in order.

The other important consideration is family history, such as a high prevalence of breast cancer, the presence of a mutation in the BRCA1 or BRCA2 genes, or hereditary susceptibility to cancer, such as Lynch syndrome.

Here at the OSUCCC-James, we are conducting the Ohio Prevention and Treatment of Endometrial Cancer (OPTEC) initiative, an effort to identify women who have endometrial cancer and screen them for Lynch syndrome as well as other cancer susceptibility genes such as BRCA. Women with Lynch syndrome have an increased risk for both endometrial and ovarian cancers, as well as colorectal cancer. In fact, women with Lynch syndrome are 10 times more likely to develop ovarian cancer than a woman at baseline risk.

Because Lynch syndrome is hereditary, when we find it we can reach out to at-risk family members and offer genetic counseling. If family members carry the genetic alteration leading to Lynch syndrome, we can provide them with long-term cancer screening and prevention strategies.

Until new ovarian cancer screening methods emerge that perform even better than those now available, the greatest tool to lower risk may come individuals understanding their cancer family history, and listening to changes in their bodies that may indicate a problem. With a better understanding of one’s risk for ovarian cancer, we hope to prevent this deadly cancer from taking hold.

Dr. David Cohn is the gynecologic oncology division director at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. 

The views expressed by contributors are their own and are not the views of The Hill.