Screening postmenopausal women for ovarian cancer: a systematic review.
OBJECTIVE
To assess ovarian cancer screening in asymptomatic, general-risk postmenopausal women. Outcomes of interest were the screening tests assessed (predictive values, sensitivity, and specificity), the stage of screen-detected disease at diagnosis, psychological effects of screening, and survival.


METHODS
MEDLINE, CANCERLIT, and the Cochrane Library databases were searched to June 2003 using the terms "ovarian," "cancer," "neoplasms," "screening," "clinical trial," "meta-analysis," and "systematic review." Studies were included if they were clinical trials, meta-analyses, or systematic reviews that evaluated tests used to detect ovarian cancer in asymptomatic women in the general population. Studies investigating women at increased risk for ovarian cancer (e.g., family history) and those with symptoms suggestive of ovarian cancer were excluded.


RESULTS
Seventeen prospective cohort studies and 3 pilot randomized controlled trials were included in this review. Screening tests for cancer antigen 125 (CA125) and ultrasound had low positive predictive values, resulting in healthy women being recalled and a false-positive rate of 0.01% to 5.8%. Of every 10,000 women participating in an annual screening program with CA125 for 3 years, 800 will have an ultrasound scan because of an elevated CA125, 30 will undergo surgery because of an abnormal ultrasound, and 6 will have ovarian cancer detected at surgery (3 will be diagnosed at early-stage disease and have a chance of a cure).


CONCLUSIONS
There is insufficient evidence to support the introduction of screening for ovarian cancer in the asymptomatic general-risk postmenopausal population. Screening is associated with increased rates of surgery and patient anxiety.
University of Ottawa, ON.
Michael Fung Kee
MF
Fung
Peter
P
Bryson
Mary
M
Johnston
Alexandra
A
Chambers
D000328:Adult; D018394:CA-125 Antigen / Q000302:isolation & purification*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000523:psychology / Q000592:standards; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D010052:Ovariectomy; D010053:Ovary / Q000000981:diagnostic imaging* / Q000473:pathology; D017698:Postmenopause; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D018394:CA-125 Antigen