3 - Ovarian Cancer Screening

Summary

Introduction

Ovarian cancer remains not only the commonest but also the most lethal gynaecological malignancy in the UK (Table 3.1 [1]).

Despite advances in molecular biology, surgery and chemotherapy, ovarian cancer remains a difficult condition to manage and long-term survival rates have hardly improved since the 1970s [2]. The poor prognosis of the disease is believed to be due to the fact that more than 70% of women present with disease spread beyond the ovaries (Table 3.2 [3]). This probably reflects the absence of major symptoms in early stage disease, due to the location of the ovaries, which results in little interference with surrounding structures until ovarian enlargement is considerable or metastatic disease supervenes. When symptoms occur, they may be non-specific, requiring frequent consultations with a GP before further investigation is prompted. However, it should be noted that most stage I ovarian cancers have an extremely good prognosis following surgery alone. Detection of early stage disease may therefore offer an opportunity to reduce mortality. However, so far, no screening protocol for ovarian cancer has been shown to achieve this aim. Nevertheless, developments in ultrasound and tumour marker technology, combined with more sophisticated approaches to interpretation have improved the performance of the potential screening strategies to levels which may reduce mortality. These strategies are currently being tested in two large randomised controlled trials of ovarian cancer screening; one in the UK [4] and one in the USA [5]. However, neither of these is expected to report before 2012.