The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) has shown that general population screening did not significantly reduce ovarian and tubal cancer deaths, and the researchers concluded that such screening cannot be recommended. The findings from the study prompted the Ovarian Cancer Research Alliance (OCRA) to issue a consensus statement on January 30, urging patients—even those without a genetic mutation for the disease—to consider having their fallopian tubes surgically removed if they have had children and are undergoing pelvic surgeries for benign conditions, such as hysterectomy. The move was endorsed by the Society of Gynecology Oncology.
Screening Does Not Save Lives and Can Cause Harm
In its consensus statement, OCRA explained it was issuing the recommendation because the findings from the UKCTOCS study illustrated that current screening methods not only do not save lives in the general population, but they can also cause harm, including false-positive tests and unnecessary surgeries that can lead to emotional and physical risks to patients as well as financial hardship. The study also found that promoting symptom awareness does not save lives.
In addition to finding that screening average-risk patients with the CA-125 biomarker blood test and pelvic imaging using transvaginal ultrasound scans does not reduce ovarian cancer mortality, the study found that identifying patients with stage I or stage II ovarian cancer did not impact their mortality—an important finding, since these individuals were estimated to have been diagnosed an average of 18 months prior to the onset of symptoms.
“These [patients] seem to have had a cancer that was just inherently more aggressive. Detecting it at an earlier stage was not enough to prevent them from dying from the disease and did not prolong their lives,” according to the OCRA statement.
Reducing the Risk of Ovarian Cancer
Acknowledging that developing an early detection approach for average-risk individuals that would dramatically improve outcomes is likely 10 to 20 years in the future, OCRA is recommending that all women, or anyone born with ovaries, know their risk for ovarian cancer and consider having their fallopian tubes removed if they are finished having children and are planning pelvic surgeries for benign conditions. Fallopian tube removal has been shown to dramatically reduce the risk of a later ovarian cancer diagnosis.
“Ovarian cancer is a relatively rare disease and, typically, we don’t message to the general population,” Audra Moran, President and Chief Executive Officer of OCRA, told The New York Times. “We want everyone with ovaries to know their risk level and know the actions they can take to help prevent ovarian cancer.”
Stephanie V. Blank, MD, Director of Gynecologic Oncology at the Mount Sinai Health System and President of the Society of Gynecologic Oncology, admitted that while promoting prophylactic removal of the fallopian tubes in women without genetic risks “is considered experimental, it makes scientific sense and has a lot of appeal,” she said in The New York Times. “Removing the tubes is not as good as removing the tubes and the ovaries, but it’s better than screening, which doesn’t work.”
According to the American Cancer Society, ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. This year, ACS is predicting that about 19,710 individuals will be diagnosed with ovarian cancer, and about 13,270 of them will die from the disease.
