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Screening of Ovarian Cancer .ppt
1. Clinical Practice
Screening for Ovarian Cancer
Daniel L. Clarke-Pearson, M.D.
N Engl J Med
Volume 361(2):170-177
July 9, 2009
2. Case Vignette
• A 56-year-old woman presents to her physician, requesting screening for
ovarian cancer.
• She reports the recent death of a friend from ovarian cancer at the age
of 65 years.
• The patient has no family history of ovarian or breast cancer.
• The physical examination, including pelvic and rectal examination, is
normal.
• Should the physician recommend screening for ovarian cancer?
3. Outline
• The Clinical Problem
• Strategies and Evidence
– Routine Screening
– Ultrasonography
– Tumor Markers
● CA-125
● Other Markers
– Ongoing Screening Trials
– Screening for High-Risk Women
• Areas of Uncertainty
• Guidelines
• Conclusions and Recommendations
4. Stage of Ovarian Cancer at Diagnosis and Survival at 5 Years
Clarke-Pearson D. N Engl J Med 2009;361:170-177
10. Conclusions and Recommendations
• Ovarian cancer that is diagnosed on the basis of symptoms is often at an
advanced stage.
• Early detection, which is associated with improved survival, depends on
effective screening strategies.
• Studies have shown that screening with the use of serum tumor markers
(especially CA-125), ovarian imaging with transvaginal ultrasonography,
or a multimodal strategy can detect ovarian cancer at an earlier stage,
but trials that have been completed to date have not included a control
group for direct comparison, and no trial has yet shown improved overall
survival for women undergoing screening.
• Pending the results of the two large ongoing, randomized, controlled
trials, I would advise against screening in a patient who is at average
risk, such as the woman described in the vignette.
