OVARIAN CANCER SCREENING  5/29/07

1. The American Cancer Society estimates that in 2007 there will be 22,430 new cases of ovarian cancer in the United States, and 15,280 women will die of this disease.^[1] Although the lifetime risk of ovarian cancer is very low, the mortality rate is high, and the 5-year survival rate is less than 50%.^[2] Life expectancy with ovarian cancer has been slow to improve because the prognosis for this disease is largely dependent on early diagnosis, and there are at the present time no reliable methods to identify ovarian cancer at an early stage. However, identifying women at risk for ovarian cancer enables clinicians to offer 2 tests that might signal the need for further diagnostic testing in a specific population.

1. The single greatest indicator of risk is family history of ovarian cancer, in either the maternal or paternal line. In families with a history of early-onset breast cancer caused by mutations in breast cancer genes BRCA1 and BRCA2, ovarian cancer risk is further increased. There is also an increased risk of ovarian cancer in families with nonpolyposis colorectal cancer

1. Additional risk factors for ovarian cancer include increasing age (the disease is very rare in women under 30 years) and nulliparity. Data also suggest that women who have used fertility drugs but were unable to get pregnant may also be at increased risk.^[3] However, women who used oral contraceptives have consistently been found to be at lower risk, including those who are BRCA1 and BRCA2 carriers.^[4]

1. Although there are no standard screening tests for ovarian cancer, there are 2 tests that may, in some women, raise a “red flag” of concern. These tests are not considered true screening tests and, in fact, there are risks associated with these tests (for example, when interventions are based on false-positive results)

1. The first of these tests is the CA-125 assay. This is a blood test that measures a tumor-associated antigen released by cancer cells. It is most often used to measure the effect of treatment for this disease; however, in some instances it can reveal an undiagnosed cancer. Unfortunately, CA-125 is not specific for ovarian cancer; it can also be elevated in a woman during her first trimester of pregnancy^[5] or if she has endometriosis.^[

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