Ovarian cancer affects about 1 percent of women, but it has a high mortality rate — about 14,000 deaths each year. Still, new guidelines recommend women who are not at high risk for the disease should avoid screening for it.
“Basically, it just doesn’t work,” says Dr. Matt Carlson, a gynecologic cancer specialist with UT Southwestern Medical Center. “The false-positive rate for any screenings that they’ve done led to a number of unnecessary surgeries.”
Early detection is key to successful treatment of any disease, so Carlson recommends women with a low risk for ovarian cancer should see a doctor if they experience symptoms.
About ovarian cancer: It’s a relatively rare disease. Unfortunately, though, we diagnose it at a late stage most often. That has a lot to do with the anatomy. The ovaries just kind of sit out in the abdomen and pelvis. A mass can grow there and many women don’t know it. By that time, cancer cells may have found in another place within the abdomen to start another tumor, at which point it would be Stage 3 disease. The survival for that decreases precipitously.
Why recommend against screening? Basically, it just doesn’t work. There are three large studies and they found that for ultrasound or CA-125 or any combination of screening that they’ve done, the false-positive rate led to a number of unnecessary surgeries. And according to one of the studies, the serious complication rate, whether that was a wound infection or some other complication, was about 15 percent. So, you’re essentially doing 10 surgeries to find one cancer. Of those 10 surgeries, only one or two of them are going to have some sort of complication.
Fewer screenings or none at all? No screening at all with the CA-125 or the ultrasound. They have shown that those do not help. That’s partly due to the lack of specificity of those tests. The ultrasound can see things, but we don’t know if those are cancerous cysts, or masses on the ovaries, or if those are benign. Similarly, the CA-125 is really a measure of inflammation of the peritoneum, which is kind of the wallpaper of the abdomen. There are a lot of things: endometriosis, which is a very common condition that many women suffer from. Even something as simple as gastroenteritis, which we all suffer from time to time; that can elevate the CA-125. The lack of specificity of those tests is what limits their utility in screening.
Symptoms low-risk women should watch for:
Some persistent combination of:
- Back Pain
- Changes in bowel habits
- Changes in bladder habits
- Changes in appetite
- Early satiety – feeling full after only a few bites
- Pelvic or abdominal pain
- Feeling the need to urinate urgently or often
- Upset stomach or heartburn
- Pain during sex
- Constipation or menstrual changes
Interview responses have been lightly edited for clarity.