title: 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.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Macmillan Nurse Specialist in Genetics, Southeast of Scotland Clinical Genetic Services, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU Scotland. diane.stirling@luht.scot.nhs.uk
authors.forename: Diane
authors.initials: D
authors.lastname: Stirling
authors.forename: D Gareth R
authors.initials: DG
authors.lastname: Evans
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pichert
authors.forename: Andrew
authors.initials: A
authors.lastname: Shenton
authors.forename: Elaine N
authors.initials: EN
authors.lastname: Kirk
authors.forename: Sylvia
authors.initials: S
authors.lastname: Rimmer
authors.forename: C Michael
authors.initials: CM
authors.lastname: Steel
authors.forename: Sheila
authors.initials: S
authors.lastname: Lawson
authors.forename: R M Camille
authors.initials: RM
authors.lastname: Busby-Earle
authors.forename: Jane
authors.initials: J
authors.lastname: Walker
authors.forename: Fiona I
authors.initials: FI
authors.lastname: Lalloo
authors.forename: Diana M
authors.initials: DM
authors.lastname: Eccles
authors.forename: Anneke M
authors.initials: AM
authors.lastname: Lucassen
authors.forename: Mary E
authors.initials: ME
authors.lastname: Porteous
mesh_terms: D000328:Adult; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000235:genetics; D018570:Risk Assessment; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen