does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.
The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.
The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.
The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.
Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.
The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.
The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.
The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.
The task force members had no financial conflicts to disclose.
SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.