Screening could reduce mortality from the disease by about 20% after a 14 year screening trial has been conducted. Over 200,000 women were assessed over a 14 year period. One group was annually screened and the other was not.
However, researchers from the United Kingdom Collaborative Trial of Ovarian Cancer (UKCTOCS) caution that longer follow-up is needed to determine the ultimate mortality reduction from screening and to determine whether screening in the general population is cost-effective.
The mortality rate of reduction and the cost-effectiveness of general population annual screening is being called into question by the United Kingdom Collaborative Trial of Ovarian Cancer (UKCTOCS). The researchers believe that a longer follow-up is required to determine these outstanding factors.
"This is the first-ever evidence to suggest that screening for early detection of ovarian cancer may save lives," Ian Jacobs, MD, president and vice-chancellor of the University of New South Wales in Sydney, Australia.
"More follow-up is needed, but the results are encouraging and exciting and open up the possibility that many lives could be saved," said Dr Jacobs, who led the trial with Usha Menon, MD, from the Institute for Women's Health, University College London, United Kingdom.
"We have the first evidence that ovarian cancer screening can save lives, but we need further follow-up to confirm the findings," added Dr Usha Menon.
"However, screening is not without harms, which include some women undergoing surgery to find they only have benign ovarian lesions or normal ovaries," she told Medscape Medical News.
The study was conducted on a randomized group of more than 200,000 women from June 2001 to October 2005 to one of three group: 50,624 underwent annual multimodality screening, which consisted of a serum cancer antigen 125 (CA125) test interpreted with the risk of ovarian cancer algorithm (ROCA) plus ultrasound; 50,623 underwent annual transvaginal ultrasound screening alone; and 101,299 underwent no screening.
Screening ended in December 2011, 345,570 multimodality screens and 327,775 ultrasound screens were then evaluated.
All women evaluated were postmenopausal, 50 to 74 years of age, and had no symptoms or history of ovarian cancer, or nonovarian malignancy.
There was a reduction in the rate of death from ovarian cancer of 15% in the multimodality group and of 11% in the ultrasound group.
The reduction in mortality was 8% in the first 7 years and 23% in the subsequent 7 years for the multimodality group and the reduction in mortality was 2% in the first 7 years and 21% in the subsequent 7 years for the ultrasound group.
In total there was an average reduction in mortality of 20% in favour of multimodality screening.
Cancer was detected at an early stage in more patients in the multimodality group (39%) than in the no-screening group (26%).
"If only 59% of ovarian cancer cases are detected by screening plus ultrasound, we will need to focus on why and how screening — as undertaken within UKCTOCS — still has a significant, but delayed, survival effect. Trying to unravel the mechanism behind this effect so that it can be improved should have a high priority," René H.M. Verheijen, MD, and Ronald P. Zweemer, MD, from the UMC Utrecht Cancer Center in the Netherlands.
Ovarian cancer detection rates are better when the CA125 serum levels are evaluated overtime as changes happen as opposed to the traditional cutoff points.
"On the basis of current evidence, the multimodal strategy using CA125 in the risk of ovarian cancer algorithm, followed by ultrasound as a secondary test where needed, seems to have the highest sensitivity or detection rate, the lowest false-positive rate, and the best evidence for a mortality reduction," Dr Jacobs stated.
"Some women will wish to access screening on an individual basis, having taken the view that, for them, the balance of benefit, harm, and cost makes it worthwhile. This decision will depend upon many factors, including a woman's level of risk of ovarian cancer, her views on health and screening, and the cost involved. Our advice is that women considering accessing screening should make a fully informed decision, having taken medical advice," said Dr. Jacobs.
Researchers and experts agree that longer follow-up is necessary to determine how effective annual screening will turn out to be.
To date, it is suggested that approximately 15 deaths could be prevented with CA125 screening for every 10,000 women screened, according to Dr Mckenzie. However it was also reported that for every woman that"However, for every woman with a positive screen who underwent surgery and was found to have ovarian cancer, two did not," she added.
"The benefits were modest in this trial. Only 59% of ovarian cancers were detected early with multimodality, and 51% in the ultrasound group. A large number of women must be screened to see benefit. The authors estimate that 641 women must be screened annually to prevent one ovarian cancer death. It remains unclear whether these results are generalizable to a large population, and the cost-effectiveness of the strategy has not been calculated. The mortality reductions require a long time frame before significant differences are seen between screened and unscreened populations," Dr Gary Leiserowitz explained.
The majority of the reactions about the potential of the study is very positive. It is highlighted however that the research needs to be conducted for longer in order to establish the overall benefits and determine the cost associated with general population screening.
The benefits of health screening can be felt by both the employer and the employee alike. Health screening is an effective way of increasing employee morale, and leads to reduced sickness and levels of absenteeism.
Smoking Cessation Programmes, Carbon Monoxide Lung Analysis, Cardiovascular Risk Assessment, Alcohol Awareness/Risk Assessment, Spirometry, Celiac Testing, Weight and Stress Management.