Ovarian Cancer Screening of The Future

Most women harboring an ovarian cancer will not recognize the fact that a cancer is developing in their ovary. Eventually the cancer becomes more advanced, symptoms may then be pronounced and then the disease is recognized. Some women are taught to recognize signs of ovarian cancer because they are at greater risk of developing ovarian tumors.  Women with BRCA 1 or 2 mutations, those with strong family history of breast or ovarian cancers, women who have never had children, women who have never breastfed, and women who have spent greater portions of their life ovulating because they never used birth control pills are all a bit more likely to get ovarian cancer. These women have been targeted for more careful watching in some studies looking at ways to diagnose ovarian cancer early. If effective screening could be performed, we can identify who these women are who have an ovarian cancer at an earlier stage when it is much more treatable. A screening test is a test for women with no symptoms at all. A study from the University of Kentucky Ovarian Cancer Screening Trial, which has been underway since 1987, studied women over 25 with family history of ovarian cancer and a personal history of cysts, BUT ALSO women over the age of 50 who had NO SYMPTOMS were targeted for ovarian cancer screening. They had a plan to check out any ovarian cysts seen on ultrasound that persisted for over 6 weeks with blood tests, sophisticated color flow ultrasound; and they had a definite plan on doing surgery if there was suspicion of cancer. If a woman has a cyst she has about 7% chance that this cyst is cancerous if she hasn't gone through menopause, that number rises to about 30% if she is menopausal. With just doing ultrasound screening in patients who have symptoms or risk we only find about 15% of the cancers in stage I, the most treatable stage. The good news is that with their plan, almost half (47%) of all tumors were found to be in stage I.  Not only that, but in this Kentucky trial women were much more likely to survive from ovarian cancer, if they had been screened with the ultrasound test. It is beginning to look like this may indeed develop into a good strategy for women. Now the authors are still worried that they have too healthy of a group of patients, and that in fact their statistics may not really support wide spread screening just yet. Currently their work is being additionally validated by the UK Collaborative Trial of Ovarian Cancer Screening. Those results won’t be ready until 2015, and we think, therefore, that there will be reasons to change how we care for women in the next few years. but one fact holds firm: if you have unexplained or persistent symptoms like abdominal pain or bloating, please see your gyno for evaluation. 



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