Ovarian cancer screening: yes or no?

In the United States, unnecessary medical tests and procedures are so common that they’re, well, a trillion, billion dimes a dozen! The Lown Institute says that up to $800 billion a year is wasted on overuse of medical care, meaning medical tests, treatments and other services that patients don’t need or want. It’s estimated that unnecessary tests alone rack up $200 billion annually.

So what should you make of the recent recommendation from the U.S. Preventive Services Task Force that says screening for ovarian cancer is not a good idea for most women without a high risk of developing the disease, since getting screened doesn’t decrease the risk of dying from that cancer?

Screening involves a blood test to check for the CA-125 antibody and a transvaginal ultrasound. The USPSTF evidence report found one per cent of women who had the CA-125 test underwent ovarian cancer surgery that they did not need. And three per cent of women who had the transvaginal ultrasound test (with or without also getting the CA-125 test) were mistakenly subjected to surgery for ovarian cancer. Major complications occurred in three to 15 per cent of women who had those unnecessary surgeries. On the other hand, we know that only about 20 per cent of cases of ovarian cancer are caught in the early stages, when the five-year survival rate is 94 per cent.

USPSTF says screening has no benefit for asymptomatic women at average risk. It should be reserved for those at high risk.

So who is at increased risk? According to Memorial Sloan Kettering Cancer Center in New York City, increased risk is defined as a relative risk three to six times greater than that of the general population.

MSK says for these women: “There is no clear evidence to suggest that ovarian cancer screening with currently available methods will result in a decrease in the number of deaths from ovarian cancer.”

However if you feel uncertain about skipping the screening, MSK says that, “Preliminary evidence has suggested that (for) women with a strong family history of breast cancer but no demonstrable mutation in BRCA1 or BRCA2 ... genetic counseling may also be helpful ... to better clarify the risk of ovarian and related cancers.”

You are at increased risk if:

■ Your mother, sister or daughter has had ovarian cancer.

■ You had breast cancer before the age of 40.

■ You had breast cancer before age 50 plus one or more close relatives were diagnosed with breast or ovarian cancer at any age.

■ Two or more of your close relatives were diagnosed with breast cancer before age 50 or with ovarian cancer at any age.

■ Your father or brother had breast or pancreatic cancer at any age.

■ You have Ashkenazi Jewish heritage and a first- or seconddegree relative diagnosed with breast cancer before age 50 or with ovarian cancer at any age.

What about high risk? If you have inherited genetic mutations, you have a relative risk that’s six or more times greater than the general population. This highrisk group includes anyone with:

■ Presence of a BRCA1 or BRCA2 mutation.

■ Presence of a mismatch repair gene mutation associated with a hereditary cancer syndrome known as hereditary nonpolyposis colon cancer, or Lynch syndrome.

Screening guidelines

You should have ovarian cancer screening using a combination of transvaginal ultrasound and CA125 testing beginning between age 30 and 35, if you have mutations in BRCA1 or the mismatch repair genes, MLH1, MSH2 and MSH6. If you have mutations in BRCA2, screening should begin between ages 35 and 40, and every two to five years after that. So talk with your doc to see if you should have a genetic test or basic ovarian cancer screening regularly.