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Experts Agree: No Evidence to Support Ovarian Cancer Screening
23 September 2009
In an Australian first, leading experts and organizations have agreed a position statement on screening for ovarian cancer, Australia's leading cause of death from gynecological malignancy.
According to a National Breast and Ovarian Cancer Centre (NBOCC) position statement published in the October edition of the Australian and New Zealand Journal of Obstetrics and Gynaecology (published by Wiley-Blackwell), there is no evidence to support the use of any test, or combination of tests currently available, to screen asymptomatic women for ovarian cancer on an individual basis or through a population-based screening approach.
The position was agreed at a NBOCC Expert Forum in Sydney, which brought together key stakeholders in ovarian cancer across Australia.
NBOCC's position statement, Population screening and early detection of ovarian cancer in asymptomatic women, has been endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian College of General Practitioners, the Australian Society of Gynecologic Oncologists, Cancer Council Australia and the Screening Subcommittee of the Australian Government Department of Health and Ageing.
Each year in Australia about 1300 women are diagnosed with ovarian cancer. However, over 70 per cent of women are diagnosed when the disease is advanced and difficult to treat successfully. Only four out of ten women will survive five years beyond their diagnosis.
Dr Helen Zorbas, CEO, NBOCC said: "We know that to improve the mortality rate for ovarian cancer, early detection of the disease is critical. However, there is currently no evidence that any test, or combination of tests, will achieve this in the screening setting."
In reviewing the available evidence, Australian experts agreed:
1. There is currently no evidence that any test, including pelvic examination, CA125 or other biomarkers, ultrasound (including transvaginal ultrasound), or combination of tests, results in reduced mortality from ovarian cancer.
2. There is no evidence to support the use of any test, including pelvic examination, CA125, or other biomarkers, ultrasound (including transvaginal ultrasound), or combination of tests, for routine population-based screening for ovarian cancer.
3. Further validation in large clinical trials is required before current or new biomarkers could be recommended for routine use in a population screening setting.
"This position statement supports health professionals, particularly general practitioners, who are often consulted by patients without symptoms seeking a screening test for ovarian cancer," Dr Zorbas said.
Professor Jonathan Carter, Chairman of the Australian Society of Gynecologic Oncologists and member of an expert panel involved in the development of the statement, said: "Testing for ovarian cancer in asymptomatic women can lead not only to false reassurance for women, but can also result in unnecessary and highly invasive procedures on the basis of a false positive."
"We simply don't have the evidence to recommend routine testing for ovarian cancer among asymptomatic women," said Professor Carter.
To assist health professionals in discussing the issue of ovarian cancer screening with their patients, NBOCC has developed a set of frequently asked questions.
Population screening and early detection of ovarian cancer in asymptomatic women and Frequently asked questions about screening for ovarian cancer are available online at www.nbocc.org.au.
National Breast and Ovarian Cancer Centre is funded by the Australian Government and works with consumers, health professionals, cancer organisations, researchers and governments to improve care and cancer control in breast and ovarian cancer.