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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

9.6 Ovarian cancer

Age 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

Table 9.6.1. Ovarian cancer: Identifying risk
Who is at risk?What should be done?How often?
Lower risk
Those who have used the oral contraception or carried a pregnancy to term (risk of about half the population average) No screening 102
Higher risk
  • Family history of ovarian cancer, especially first-degree relatives and more than one relative (risk of about 3 times the population average)
  • Presence of the genes BRCA1 or BRCA2 104
No screening 103

Consider increased frequency of screening for breast and colorectal cancer (CRC)
CRC, colorectal cancer

References

  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 2011;305:2295–303.
  2. 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.
  3. US Preventive Services Task Force. Screening for ovarian cancer: Reaffirmation recommendation statement. Am Fam Physician 2013;87(10):Online.
  4. 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.
  5. Kerlikowske K, Brown JS, Grady DG. Should women with familial ovarian cancer undergo prophylactic oophorectomy? Obstet Gynecol 1992;80:700–07.
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