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  • Screening for Ovarian Cancer

    The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
    Screening tests are designed to find patients with early cancer or those who are high risk. Whenever you go for a screening procedure, be certain to tell your screener if you have any risk factors, especially a family history.
    • Pelvic exam—Your annual checkup includes a Pap smear for cervical cancer and a pelvic exam for other female disorders, among them ovarian cancer . If you have a history of breast cancer or a mother or sister with ovarian cancer, make sure your healthcare provider is aware of your increased risk. If she cannot do a satisfactory pelvic exam (because of your weight, your anatomy, or the discomfort it causes), an ultrasound may be worthwhile.
    • Ultrasound—Imaging tests like the ultrasound are not recommended as a routine screening test, but they may be used as the next step if you are at high risk for ovarian cancer. Your doctor may use a transvaginal ultrasound, which gives satisfactory images of the pelvic organs. This type of ultrasound involves the use of a portable machine and a probe, which is inserted into your vagina.
    • Blood tests— CA-125 is a substance that is found in elevated levels in many women with ovarian cancer. However, it is also elevated in women without cancer and is not elevated in all women who do have ovarian cancer, so it is not a very good test for screening all women. Your doctor may order this test if you are at high risk for ovarian cancer. Because there can be an association between breast and ovarian cancer, your doctor may also recommend screening for genetic predisposition to breast cancer, as well.
      • Screening with the transvaginal ultrasound and the CA-125 blood test remains controversial. While the combined tests are able to detect ovarian cancer in some women without symptoms, they have also lead to unnecessary surgery. In addition, it is not known whether the screening has any impact on mortality.
    Until there is more conclusive evidence, have a yearly pelvic exam, and ask your doctor if you have any risk factors that would warrant additional testing. Currently, most insurers will not cover a periodic transvaginal ultrasound or a CA-125 blood test. You may have to pay for this yourself or rely on reporting any new symptoms to your gynecologist as soon as possible to have the tests done.

    References

    Kasper DL, Harrison TR. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

    Ovarian cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/ovarian/ . Accessed April 8, 2009.

    6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Partridge E, Kreimer AR, Greenlee RT, et al. Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol. 2009;113:775-782.

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