Screening for Ovarian Cancer

This USPSTF recommendation was first published in: Ann Fam Med 2004;2:260-2. http://www.ahrq.gov/clinic/3rduspstf/ovariancan/ovcanrs.htm.

Clinical Considerations

• There is no existing evidence that any screening test, including CA-125, ultrasound, or pelvic examination, reduces mortality from ovarian cancer. Furthermore, existing evidence that screening can detect early-stage ovarian cancer is insufficient to indicate that this earlier diagnosis will reduce mortality.
• Because there is a low incidence of ovarian cancer in the general population (age-adjusted incidence of 17 per 100,000 women), screening for ovarian cancer is likely to have a relatively low yield. The great majority of women with a positive screening test will not have ovarian cancer (i.e., they will have a false-positive result). In women at average risk, the positive predictive value of an abnormal screening test is, at best, approximately 2 percent (i.e., 98 percent of women with positive test results will not have ovarian cancer).
• The positive predictive value of an initially positive screening test would be more favorable for women at higher risk. For example, the lifetime probability of ovarian cancer increases from about 1.6 percent in a 35-year-old woman without a family history of ovarian cancer to about 5 percent if she has 1 relative and 7 percent if she has 2 relatives with ovarian cancer. If ongoing clinical trials show that screening has a beneficial effect on mortality rates, then women at higher risk are likely to experience the greatest benefit.

CA-125 is not effective in screening for ovarian cancer.