The Yet Unrealized Promise of Ovarian Cancer Screening

The case for early detection of ovarian cancer remains as compelling as it is challenging. Early-stage disease is usually curable, but the 22 000 diagnoses that will be made in the United States this year will mostly be late-stage cancer, for which the prognosis is poor. Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging. A positive test result can be definitively evaluated only through abdominal surgery, a procedure with its own risks. Any screening approach therefore needs to avoid undue burden on unaffected women. For a rare disease (annual incidence rate of 0.0004 in postmenopausal women), this means that a screening protocol must achieve extremely high levels of accuracy, particularly for women without cancer. And finally, we need evidence that screening in fact improves survival.

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