Evidence of Stage Shift in Ovarian Cancer Detected in UK Screening Study


Key Points

  • Of 19 cases of invasive ovarian cancers detected < 1 year after prior screening, 53% were stage I or II disease.
  • Stage IIIb to IV disease was found in 36.8% of cases diagnosed < 1 year after prior screening vs 94.4% of cases diagnosed > 1 year after screening ended.

As reported in the Journal of Clinical Oncology, Rosenthal et al found evidence of a shift to an earlier stage among ovarian cancers detected in high-risk women in the UK Familial Ovarian Cancer Screening Study.

Study Details

The study was performed to evaluate performance of screening using serum cancer antigen 125 interpreted using the risk of ovarian cancer algorithm (ROCA) and transvaginal sonography in women at an estimated lifetime risk of ovarian or fallopian tube cancer of ≥ 10%. A total of 4,348 women underwent 13,728 women-years of screening at 42 UK sites between June 2007 and May 2012. ROCA screening was performed every 4 months, with transvaginal sonography performed annually if ROCA results were normal or within 2 months of abnormal ROCA results. Risk-reducing salpingo-oophorectomy was encouraged throughout the study.

Diagnosis of Invasive Disease

Median follow-up was 4.8 years. Invasive disease was diagnosed in 19 patients < 1 year after prior screening, with 13 cases being screen-detected and 6 being occult findings at salpingo-oophorectomy. No symptomatic interval cancers were observed. Of the 19 cases, 10 (52.6%) were stage I to II, including 5 of the 13 screen-detected cancers (38.5%) and 5 of the 6 occult cancers (83.3%). Modeled sensitivity, positive predictive value, and negative predictive value for detection of disease within 1 year were 94.7%, 10.8%, and 100%, respectively.

Among the 19 cases diagnosed within 1 year after prior screening, 7 (36.8%) were stage IIIb to IV, compared with 17 of 18 cancers (94.4%) diagnosed > 1 year after screening ended (P < .001). Postsurgical zero residual disease occurred in 18 of the 19 cancers (94.8%) diagnosed < 1 year vs 13 of 18 cancers (72.2%) diagnosed at > 1 year after screening ended (P = .09).

The investigators concluded: “ROCA-based screening is an option for women at high risk of [ovarian cancer/fallopian tube cancer] who defer or decline [risk-reducing salpingo-oophorectomy], given its high sensitivity and significant stage shift. However, it remains unknown whether this strategy would improve survival in screened high-risk women.”

The study was supported by Cancer Research UK, The Eve Appeal, and the UK National Institute for Health Research.

Ian J. Jacobs, MD, of the University of New South Wales Australia, is the corresponding author of the Journal of Clinical Oncology article.

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