Endeavors magazine: Should you be screened for ovarian cancer?

Daniel Clarke-Pearson thinks that unless you’re in a high-risk group, the answer is probably no. Clarke-Pearson says that the two tests doctors typically use aren’t reliable.

A transvaginal ultrasound can detect abnormalities in the ovaries, but the test returns a lot of false positives: some studies have shown that up to 80 percent of the ovary-removal surgeries it prompted were unnecessary. A blood test can detect high levels of a protein called CA-125, which may suggest ovarian cancer. But the CA-125 test is not very sensitive, and it’s unable to detect early-stage cancers.

And no matter which test doctors use, they still have to resort to surgery to definitively diagnose ovarian cancers. In its early stages, ovarian cancer’s symptoms, which include bloating and pelvic or abdominal pain, can be mistakenly attributed to other maladies. Sometimes symptoms may not fully develop until the disease has reached a later stage.

Clarke-Pearson says you should be screened if:

• you have or have had breast cancer, or have a family history of breast or ovarian cancer;
• you have the BRCA1 or BRCA2 gene mutation (which can be detected by a blood test);
• you are fifty years of age or older and have had any of the following specific symptoms more than twelve times in one month over the past year: pelvic or abdominal pain, urinary frequency or urgency, increased abdominal size or bloating, or difficulty eating or feeling full.

“There is no evidence to date that screening would result in fewer deaths from ovarian cancer,” Clarke-Pearson says. “We still have a lot of research to do.”

Daniel Clarke-Pearson is the chair of the Department of Obstetrics and Gynecology in the School of Medicine. An article on his research appeared in the July 9, 2009, issue of the New England Journal of Medicine.