Red Book

Early detection of cancers

Ovarian cancer

Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

Not recommended as a preventive activity

Screening in asymptomatic, low-risk women is not recommended. Screening methods for ovarian cancer employ blood tests for cancer antigen (CA) 125, or transabdominal or transvaginal ultrasound.

There are three large randomised trials on ovarian cancer screening:

  • the United States Prostate, Lung, Colorectal and Ovarian trial (PLCO), which reported in 2011;99
  • the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) in late 2015;100
  • a European trial, which commenced in 2005 and has not reported yet.

The UK trial found a small reduction in ovarian deaths from CA125, and transvaginal ultrasound for routine population-based screening for ovarian cancer.

However, the results are regarded as preliminary, requiring confirmation and longer follow-up100 and, in the meantime, the US Preventive Services Task Force (USPSTF) recommends against ovarian cancer screening.101

 Ovarian cancer: Identifying risk

Table 9.6.1

Ovarian cancer: Identifying risk

  1. Cancer Council Australia. Community Care and Population Health Principal Committee of the Australian Health Ministers’ Advisory Council ; NHMRC summary of the evidence. Sydney: Cancer Council Australia, 2014.
  2. Djulbegovic M, Beyth RJ, Neuberger MM, et al. Screening for prostate cancer: Systematic review and meta-analysis of randomised controlled trials. BMJ 2010;341:c4543.
  3. National Health and Medical Research Council. PSA testing for prostate cancer in asymptomatic men. Information for health practitioners. Canberra: NHMRC, 2014.
  4. Lim LS, Sherin K, ACPM Prevention Practice Committee. Screening for prostate cancer in US men: ACPM position statement on preventive practice. Am J Prev Med 2008;34(2):164–70.
  5. Bruner DW, Moore D, Parlanti A, Dorgan J, Engstrom P. Relative risk of prostate cancer for men with affected relatives: Systematic review and meta-analysis. Int J Cancer 2003;107(5):797–803.
  6. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int 2003;91(9):789–94.
  7. Zeegers MP, Jellema A, Ostrer H. Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: A meta-analysis. Cancer 2003;97(8):1894–903.
  8. Ilic D, O’Connor D, Green S, Wilt TJ. Screening for prostate cancer: An updated Cochrane systematic review. BJU Int 2011;107(6):882–91.
  9. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev 2013;1:CD004720.
  10. Moyer on behalf of US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 2012;157(2):120–34.
  11. Alemozaffar M, Regan MM, Cooperberg MR, et al. Prediction of erectile function following treatment for prostate cancer. JAMA 2011;306(11):1204–14.
  12. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008;358(12):1250–61.
  13. Fang F, Keating NL, Mucci LA, et al. Immediate risk of suicide and cardiovascular death after a prostate cancer diagnosis: Cohort study in the United States. J Natl Cancer Inst 2010;102(5):307–14.
  14. Fall K, Fang F, Mucci LA, et al. Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: Prospective cohort study. PLoS Med 2009;6(12):e1000197.
  15. Bowden FJ, Roberts J, Collignon PJ. Prostate cancer screening and bacteraemia (letter). Med J Aust 2008;188(1):60.
  16. Gattellari M, Ward J. Does evidence-based information about screening for prostate cancer enhance consumer decision-making? A randomised controlled trial. J Med Screening 2003;10:27–29.
  17. Hewitson P, Glasziou PP, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007;1:CD001216.
  18. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J. Evaluating test strategies for colorectal cancer screening-age to begin, age to stop, and timing of screening intervals: A decision analysis of colorectal cancer screening for the US Preventive Services Task Force from the Cancer Intervention and Surveillance Modeling Network (CISNET). Rockville, MD: Agency for Healthcare Research and Quality, 2009.
  19. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia and Australian Cancer Network, 2005.
  20. Viiala CH, Zimmerman M, Cullen DJ, Hoffman NE. Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J 2003;33(8):355–59.
  21. Rabeneck L, Paszat LF, Hilsden RJl. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008;135(6):1899–906, 906 e1.
  22. US Preventive Services Task Force. Draft Recommendation Statement – Colorectal Cancer: Screening. 2015 draft-recommendation-statement38/colorectal-cancerscreening2#citation10 [Accessed 15 October 2015].
  23. Cooper K, Squires H, Carroll C, et al. Chemoprevention of colorectal cancer: Systematic review and economic evaluation. Health Technol Assess 2010;14(32):1–206.
  24. National Cancer Institute. Colorectal cancer screening (PDQ®) – Health Professional Version. US National Institutes of Health, 2012 HealthProfessional/page4 [Accessed 2015 October].
  25. Australian Cancer Network. Familial aspects of bowel cancer: A guide for health professionals. Canberra: National Health and Medical Research Council, 2002.
  26. National Cancer Institute. Genetics of colorectal cancer (PDQ®) – Health Professional Version. US National Institutes of Health, 2012 cancertopics/pdq/genetics/colorectal/HealthProfessional/ page1 [Accessed 15 October 2015].
  27. Burn J, Gerdes AM, Macrae F, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial. Lancet 2011;378(9809):2081–87.
  28. Rothwell PM, Fowkes PG, Belch JP, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long term risk of death due to cancer – Analysis of individual patient data from randomised trials. Lancet 2011;377(9759):31–41.
  29. Rothwell PM, Wilson M, Elwin CE, et al. Long term effect of aspirin on colorectal cancer incidence and mortality: 20 year follow up of 5 randomized controlled trials. Lancet 2010;376(9754):1741–50.
  30. Cancer Council Australia Colonoscopy Surveillance Working Party. Clinical practice guidelines for surveillance colonoscopy – In adenoma follow-up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease. Sydney: Cancer Council Australia, 2011.
  31. van Dam L, Kuipers EJ, van Leerdama ME. Performance improvements of stool-based screening tests. Best Pract Res Clin Gastroenterol 2010;24(4):479–92.
  32. Holden DJ, Jonas DE, Porterfield DS, Reuland D, Harris R. Systematic review: Enhancing the use and quality of colorectal cancer screening. Ann Intern Med 2010;152(10):668–76.
  33. Steinwachs D, Allen JD, Barlow WE, et al. National Institutes of Health state-of-the-science conference statement: Enhancing use and quality of colorectal cancer screening. Ann Intern Med 2010;152(10):663–67.
  34. Pignone MP, Flitcroft KL, Howard K, Trevena LJ, Salkeld GP, St John DJB. Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia. Med J Aust 2011;194(4):180–85.
  35. Zapka J, Taplin SH, Anhang Price R, Cranos C, Yabroff R. Factors in quality care – The case of follow-up to abnormal cancer screening tests – Problems in the steps and interfaces of care. J Natl Cancer Inst Monogr 2010;2010(40):58–71.
  36. Senore C, Malila N, Minozzi S, Armarolia P. How to enhance physician and public acceptance and utilisation of colon cancer screening recommendations. Best Pract Res Clin Gastroenterol 2010;24(4):509–20.
  37. Department of Health and Ageing. National Bowel Cancer Screening Program: About bowel screening. Canberra: DoHA, 2012 [Accessed 15 October 2015].
  38. Weber MF, Banks E, Smith DP, O’Connell D, Sitas F. Cancer screening among migrants in an Australian cohort; cross-sectional analyses from the 45 and Up Study. BMC Public Health 2009;9:144. doi: 10.1186/1471-2458-9-144.
  39. Evans DG, Warwick J, Astley SM, et al. Assessing individual breast cancer risk within the U.K. National Health Service Breast Screening Program: A new paradigm for cancer prevention. Cancer Prev Res (Phila) 2012;5(7):943–51.
  40. Hopper JL. Disease-specific prospective family study cohorts enriched for familial risk. Epidemiol Perspect Innov 2011;8(1):2.
  41. Goncalves AK, Dantas Florencio GL, Maisonnette de Atayde Silva MJ, Cobucci RN, Giraldo PC, Cote NM. Effects of physical activity on breast cancer prevention: A systematic review. J Phys Act Health 2014;11(2):445–54.
  42. Chen P, Li C, Li X, Li J, Chu R, Wang H. Higher dietary folate intake reduces the breast cancer risk: A systematic review and meta-analysis. Br J Cancer 2014;110(9):2327–38.
  43. Albuquerque RC, Baltar VT, Marchioni DM. Breast cancer and dietary patterns: A systematic review. Nutr Rev 2014;72(1):1–17.
  44. Jayasekara H, MacInnis RJ, Room R, English DR. Long-term alcohol consumption and breast, upper aero-digestive tract and colorectal cancer risk: A systematic review and meta-analysis. Alcohol Alcohol 2016;51(3):315–30.
  45. Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: A consensus statement. Lancet Oncol 2011;12(5):496–503.
  46. Nelson HD, Pappas M, Zakher B, Mitchell JP, OkinakaHu L, Fu R. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: A systematic review to update the US Preventive Services Task Force recommendation. Ann Intern Med 2014;160(4):255–66.
  47. Antoniou AC, Hardy R, Walker L, et al. Predicting the likelihood of carrying a BRCA1 or BRCA2 mutation: Validation of BOADICEA, BRCAPRO, IBIS, Myriad and the Manchester scoring system using data from UK genetics clinics. J Med Genet 2008;45(7):425–31.
  48. US Preventive Services Task Force. Breast cancer: Screening. Rockville, MD: USPSTF, 2015 Document/UpdateSummaryFinal/breast-cancerscreening1?ds=1&s=breast%20cancer [Accessed 15 November 2015].
  49. Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013;108(11):2205–40.
  50. Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA 2014;311(13):1327–35.
  51. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013;6:Cd001877.
  52. Walter LC, Schonberg MA. Screening mammography in older women: A review. JAMA 2014;311(13):1336–47.
  53. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breastcancer screening – Viewpoint of the IARC Working Group. N Engl J Med 2015;372(24):2353–58.
  54. Cancer Australia. MRI for high risk women. Sydney: Cancer Australia, 2015. Available at https:// [Accessed 15 November 2015].
  55. Cancer Australia. Advice about familial aspects of breast and epithelial ovarian cancer: A guide for health professionals. Sydney: Cancer Australia, 2015 publications/advice-about-familial-aspects-breastcancer-and-epithelial-ovarian-cancer/pdf/2015_bog_ familial_aspects_int.pdf [Accessed 15 November 2015].
  56. Pruthi S, Heisey RE, Bevers TB. Chemoprevention for breast cancer. Ann Surg Oncol 2015;22(10):3230–35.
  57. Bonfill X, Marzo M, Pladevall M, Marti J, Emparanza JI. Strategies for increasing the participation of women in community breast cancer screening. Cochrane Database Syst Rev 2001;1:CD002943.
  58. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: A randomised controlled trial. Lancet 1999;354(9180):723–29.
  59. Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: Randomised trial follow-up. J Clin Oncol 2011;29(3):257–63.
  60. Australian Cancer Network Melanoma Guidelines Revision Working Party. Clinical practice guidelines of the management of melanoma in Australian and New Zealand. Wellington: Cancer Council Australia and Australian Cancer Network, Sydney and New Zealand Guidelines Group, 2008.
  61. Boniol M, Autier P, Gandini S. Melanoma mortality following skin cancer screening in Germany. BMJ Open 2015;5(9):e008158.
  62. Katalinic A, Waldmann A, Weinstock MA, et al. Does skin cancer screening save lives?: An observational study comparing trends in melanoma mortality in regions with and without screening. Cancer 2012;118(21):5395–402.
  63. Usher-Smith JA, Emery J, Kassianos AP, Walter FM. Risk prediction models for melanoma: A systematic review. Cancer Epidemiol Biomarkers Prev 2014;23(8):1450–63.
  64. Watts CG, Dieng M, Morton RL, Mann GJ, Menzies SW, Cust AE. Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: A systematic review. Br J Dermatol 2015;172(1):33–47.
  65. MacKie R, McHenry P, Hole D. Accelerated detection with prospective surveillance for cutaneous malignant melanoma in high-risk groups. Lancet 1993;341(8861):1618–20.
  66. New Zealand Dermatological Society. New Zealand guidelines on the general management of malignant melanoma New Zealand. Palmerston North, NZ: NZ Dermatological Society, 2004.
  67. Baade PD, Balanda KP, Stanton WR, Lowe JB, Del Mar CB. Community perceptions of suspicious pigmented skin lesions: Are they accurate when compared to general practitioners? Cancer Detect Prev 2005;29(3):267–75.
  68. Kelly J, Chamberlain AJ, Staples MP, McAvoy B. Nodular melanoma. No longer as simple as ABC. Aust Fam Physician 2003;32(9):706–09.
  69. Scope A, Dusza SW, Halpern AC, Rabinovitz H. The ‘ugly duckling’ sign: Agreement between observers. Arch Dermatol 2008;144(1):58–64.
  70. Zalaudek I, Kittler H, Marghoob AA, Balato A. Time required for a complete skin examination with and without dermoscopy: A prospective, randomized multicenter study. Arch Dermatol 2008;144(4):509–13.
  71. National Institute for Health and Care Excellence. Suspected cancer: Recognition and referral. London: NICE, 2015.
  72. Walter FM, Prevost AT, Vasconcelos J, et al. Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: A diagnostic validation study. Br J Gen Pract 2013;63(610):e345–53.
  73. Walter FM, Morris HC, Humphrys E, et al. Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: Randomised controlled trial. BMJ 2012;345:e4110.
  74. Hanrahan P, D’Este CA, Menzies SW, Plummer T, Hersey P. A randomised trial of skin photography as an aid to screening skin lesions in older males. J Med Screening 2002;9(3):128–32.
  75. English D, Del Mar C, Burton R. Factors influencing the number needed to excise: Excision rates of pigmented lesions by general practitioners. Med J Aust 2004;180(1):16–19.
  76. Menzies SW, Emery J, Staples M, et al. Impact of dermoscopy and short-term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: A sequential intervention trial. Br J Dermatol 2009;161(6):1270–77.
  77. Kanzler M, Mraz-Gernhard S. Primary cutaneous malignant melanoma and its precursor lesions: Diagnostic and therapeutic overview. J Am Acad Dermatol 2001;45(2):260–76.
  78. Kassianos AP, Emery JD, Murchie P, Walter FM. Smartphone applications for melanoma detection by community, patient and generalist clinician users: A review. Br J Dermatol 2015;172(6):1507–18.
  79. National Health and Medical Research Council. Clinical practice guidelines non-melanoma skin cancer: Guidelines for treatment and management in Australia. Canberra: NHMRC, 2002.
  80. Czarnecki D, Mar A, Staples M, Giles G, Meehan C. The development of non-melanocytic skin cancers in people with a history of skin cancer. Dermatology 1994;189(4):364–67.
  81. Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th edn (2015 update). Canberra: Department of Health, 2015.
  82. Skinner SR, Garland SM, Stanley MA, Pitts M, Quinn MA. Human papillomavirus vaccination for the prevention of cervical neoplasia: Is it appropriate to vaccinate women older than 26? Med J Aust 2008;188(4):238–42.
  83. Cancer in Australia: an overview 2012 (online version) [Accessed 10 August 2015].
  84. Australian Government Department of Health. National Cervical Screening Program. Canberra: Department of Health, 2015 [Accessed 15 November 2015]
  85. National Health and Medical Research Council. Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities. Canberra: NHMRC, 2005.
  86. EUROGIN. Conclusions: Cervical cancer control, priorities and new directions: International charter. France, 2003.
  87. Monsonego J, Bosch FX, Coursaget P, et al. Cervical cancer control, priorities and new directions. Int J Cancer 2004;108:329–33.
  88. Buntinx F, Brouwers M. Relation between sampling device and detection of abnormality in cervical smears: A meta-analysis of randomised and quasi-randomised studies. BMJ 1996;313(7068):1285–90.
  89. Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Canadian Cervical Cancer Screening Trial Study Group. Human papillomavirus DNA versus papanicolaou screening tests for cervical cancer. N Engl J Med 2007;357(16):1579–88.
  90. Koliopoulos G, Arbyn M, Martin-Hirsch P, Kyrgiou M, Prendiville W, Paraskevaidis E. Diagnostic accuracy of human papillomavirus testing in primary cervical screening: A systematic review and meta-analysis of nonrandomized studies. Gynecol Oncol 2007;104(1):232–46.
  91. Safaeian M, Solomon D, Wacholder S, Schiffman M, Castle P. Risk of precancer and follow-up management strategies for women with human papillomavirus-negative atypical squamous cells of undetermined significance. Obstet Gynecol 2007;109(6):1325–31.
  92. Arbyn M, Paraskevaidis E, Martin-Hirsch P, Prendiville W, Dillner J. Clinical utility of HPV-DNA detection: Triage of minor cervical lesions, follow-up of women treated for high-grade CIN: An update of pooled evidence. Gynecol Oncol 2005;99(3 Suppl 1):S7–11.
  93. Arbyn M, Buntinx F, Van Ranst M, Paraskevaidis E, Martin-Hirsch P, Dillner J. Virologic versus cytologic triage of women with equivocal Pap smears: A meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst 2004;96(4):280–93.
  94. Ronco G, Cuzick J, Pierotti P, et al. Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening: Randomised controlled trial. BMJ 2007;335(7609):28.
  95. Davey E, Barratt A, Irwig L, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systematic review. Lancet 2006;367(9505):122–32.
  96. Arbyn M, Verdoodt F, Snijders PJ, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: A meta-analysis. Lancet Oncol 2014;15(2):172–83.
  97. Everett T, Bryant A, Griffin MF, Martin-Hirsch PPL, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2011;5:CD002834.
  98. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014;161(1):67–72.
  99. 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 2011;305:2295–303.
  100. Jacobs IJ, Menon U, Ryan A, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A randomised controlled trial. Lancet 2016;387(10022):945–56.
  101. US Preventive Services Task Force. Screening for ovarian cancer: Reaffirmation recommendation statement. Am Fam Physician 2013;87(10):Online.
  102. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: Collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol 1992;136:1184–203.
  103. Kerlikowske K, Brown JS, Grady DG. Should women with familial ovarian cancer undergo prophylactic oophorectomy? Obstet Gynecol 1992;80:700–07.
  104. Ford D, Easton DF. The genetics of breast and ovarian cancer. Br J Cancer 1995;72:805–12.
  105. Elford RW. Screening for testicular cancer. Canadian Task Force on the Periodic Health Examination Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada, 1994; p. 892–98.
  106. US Preventive Services Task Force. Screening for testicular cancer: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality, 2011.
  107. Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol 2004;22(1):2–14.
  108. National Cancer Institute. Testicular cancer screening. Bethesda, Maryland: US National Institutes of Health, 2012 screening/testicular/Patient/page3 [Accessed 15 October 2015].
  109. Cancer Council Australia Colorectal Cancer Guidelines Working Party. Cancer Guidelines Wiki: Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia, 2017. Available at http://wiki. [Accessed 19 June 2018].
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log