Screening For Ovarian Cancer

Dear Dr. B: I am worried about ovarian cancer. Is there a screening program for this condition?

According to Alberta Cancer Board, in year 2001, 11,730 Albertans were newly diagnosed with all types of invasive cancer, and 4,785 died from cancer. Of these, two percent of the deaths were related to ovarian cancer compared to nine percent of the deaths due to breast cancer.

In Canada, ovarian cancer is the fifth leading cause of cancer deaths among Canadian women. It causes 1500 deaths per year.

So, the number of cancer deaths due to ovarian cancer is not that high. But the problem is ovarian cancer is generally detected at an advanced stage and is associated with a five-year survival rate of about 30 percent, says an article in the Canadian Medical Association Journal (CMAJ).

The survival rates for ovarian cancer can be more than 90 percent if the cancer is detected at an early stage. But there are no effective screening methods for detecting ovarian cancer.

The CMAJ article discusses two screening strategies: ultrasound alone, or the multimodal screening approach using serum tumor marker CA125 followed by ultrasound.

Pelvic or transvaginal ultrasound has low specificity for ovarian cancer and thus many women undergo unnecessary further investigations if the findings on the ultrasound are non-specific.

One of the serum tumor markers for ovarian cancer is CA 125. It has a limited specificity. The marker is also present in the presence of other types of cancers (pancreas, breast, bladder, liver, and lung) and in some benign conditions. But the specificity of the CA 125 can be improved by adding ultrasound as a second line of investigation.

Who is at increased risk of ovarian cancer?
-10 percent of women with ovarian cancer have hereditary risk factor
-90 percent of ovarian cancers occur in post-menopausal women over the age of 50.

So, what do we know about screening for ovarian cancer?

The CMAJ article says:

-many aspects of ovarian cancer screening are poorly understood
-it is not known whether screening saves lives
-screening for ovarian cancer is not currently recommended for the general population
-over the next few years we may know more about screening once we get results from the number of trials going on in the world
-screening is an option for women with family history of ovarian cancer.

If you are worried about ovarian cancer then you should talk to your family doctor who can make the necessary recommendations to you.

A thought for the week:

“Childhood whining typically peaks some time under age seven. If you have a child who’s older and a chronic whiner, it may be because you are, too. The more we whine, the more our children will.” Barbara Meltz in The Boston Globe.

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