PRC Study Shows Gap between Reported Ovarian Cancer Screening Practices and Evidence-Based RecommendationsNovember 2012
The U.S. Preventive Services Task Force (USPSTF) is a panel of medical experts that reviews scientific evidence for clinical preventive health care services, such as cancer screening, counseling, and preventive medications. It publishes recommendations for primary care clinicians and health systems based on results of the evidence review. In September 2012, the task force reaffirmed a 2004 recommendation against ovarian cancer screening in women who have no symptoms of the disease.1 These recommendations are based on studies that show screening tests do not reduce ovarian cancer death rates. 2 One of the screening tests examines a woman’s reproductive organs (transvaginal ultrasound or TVU) and the other tests blood for a protein produced by ovarian cancer cells (cancer antigen 125 or CA-125). In addition to not reducing ovarian cancer death rates, the screening tests have a high rate of false positives, or indicating a woman has ovarian cancer when she really doesn’t. The tests are associated with potential harms, including surgery (and related complications) to remove ovaries in women who do not have cancer.2 The USPSTF recommendation applies only to women with no ovarian cancer symptoms and not to women with genetic mutations that put them at relatively high risk for ovarian cancer.
Major medical and public health organizations agree that screening for ovarian cancer in the general population is not recommended.3,4 Nevertheless, physicians have reported screening U.S. women for ovarian cancer even when screening is not recommended, as indicated by research conducted in 2008 by the University of Washington Prevention Research Center (PRC).5 The study team sent a survey to randomly selected family physicians, general internists, and obstetrician-gynecologists. The survey asked the physicians to react to several scenarios concerning preventive care (TVU and blood testing) for women at different levels of ovarian cancer risk. The survey also asked physicians about their beliefs about cancer screening, malpractice concerns, personal cancer experience, sources of information about cancer screening, practice type and location, and other characteristics.
Out of 1088 respondents, a substantial proportion of physicians’ responses to the scenarios did not adhere to the USPSTF recommendations: about 65% said they would “sometimes” or “almost always” offer or order ovarian cancer screening for women at medium risk of ovarian cancer in the scenarios, and about 28% would do so for women at low risk.5
Thirty-three percent of the physicians said they believed that TVU or blood testing was effective in detecting ovarian cancer. Doctors who held this belief, as well as doctors of patients who requested screening, were more likely to order or offer screening for the women of low or medium risk in the scenarios. Physicians reacting to patients of medium risk, and doctors who estimated the patients’ risk to be higher than the general population, also were more likely to order or offer screening.
- Screening for Ovarian Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Agency for Healthcare Research and Quality Publication No. 12-05165-EF-2, September 2012. Available at www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarcancerrs.htm
- Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. Journal of the American Medical Association. 2011 Jun 8;305(22):2295-303. Available at http://jama.jamanetwork.com/article.aspx?articleid=900666
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstetrics & Gynecology. March 2011;117:742-6. Available at http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/co477.pdf?dmc=1&ts=20120718T0626149362
- American Cancer Society. Cancer Facts & Figures 2012 [Internet]. Atlanta: American Cancer Society; 2012 [cited 2012 Sep 24]. Available from: www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
- Baldwin LM, Trivers KF, Matthews B, Andrilla CH, Miller JW, Berry DL, Lishner DM, Goff BA. Vignette-based study of ovarian cancer screening: Do U.S. physicians report adhering to evidence-based recommendations? Annals of Internal Medicine. 2012 Feb 7;156(3):182-94.