Overview

Evidence of Benefit or Lack of Benefit Associated with Screening
        Single-threshold cancer antigen 125 (CA-125) levels and transvaginal ultrasound (TVU)

Note: Separate PDQ summaries on Ovarian Cancer Prevention; Ovarian Epithelial Cancer Treatment; Ovarian Germ Cell Tumor Treatment; and Ovarian Low Malignant Potential Tumor Treatment are also available.

There is solid evidence to indicate that screening for ovarian cancer with the serum marker CA-125 and TVU does not result in a decrease in ovarian cancer mortality, after a median follow-up of 12.4 years.

Magnitude of Effect: The ovarian cancer mortality rate was 3.1 deaths per 10,000 women in the screened group and 2.6 deaths per 10,000 person-years in the usual-care group, yielding a mortality rate ratio of 1.18 (95% confidence interval, 0.82–1.71).[1]

• Study Design: Evidence obtained from one randomized controlled trial.
• Internal Validity: Good.
• Consistency: One trial has evaluated the impact on mortality from ovarian cancer.
• External Validity: Good.

Based on solid evidence, screening for ovarian cancer results in false-positive test results. Screened women had higher rates of oophorectomy and other minor complications, such as fainting and bruising.

Magnitude of Effect:

• Of screened women, 9.6% had false-positive results, resulting in 6.2% undergoing surgery. The surgical complication rate was 1.2% for all screened women.
• Oophorectomy rates among screened women compared with usual-care women were 85.7 versus 64.2, respectively per 10,000 person-years.
• Minor complications with screening: 58.3 cases per 10,000 women screened with CA-125 and 3.3 cases per 10,000 women screened with TVS.

• Study Design: Evidence obtained from one randomized controlled trial.
• Internal Validity: Good.
• Consistency: Not applicable (N/A).
• External Validity: Good.

1. Buys SS, Partridge E, Black A, et al.: Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 305 (22): 2295-303, 2011.  [PUBMED Abstract]