***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE Ovarian cancer screening with transvaginal ultrasound ( TVU ) and CA-125 was evaluated in the Prostate , Lung , Colorectal and Ovarian ( PLCO ) Trial . STUDY DESIGN This was a r and omized controlled trial of screening versus usual care . Baseline screening results are reported . RESULTS Of 39,115 women r and omized to receive screening , 28,816 received at least 1 test . Abnormal TVU was found in 1338 ( 4.7 % ) , and abnormal CA-125 in 402 ( 1.4 % ) . Twenty-nine neoplasms were identified ( 26 ovarian , 2 fallopian , and 1 primary peritoneal neoplasm ) . Nine were tumors of low malignant potential and 20 were invasive . The positive predictive value for invasive cancer was 3.7 % for an abnormal CA-125 , 1.0 % for an abnormal TVU , and 23.5 % if both tests were abnormal . CONCLUSION The effect of screening on ovarian cancer mortality in the PLCO cohort has yet to be evaluated and will require longer follow-up . Screening identified both early- and late-stage neoplasms , and the predictive value of both tests was relatively low Summary Background Ovarian cancer has a poor prognosis , with just 40 % of patients surviving 5 years . We design ed this trial to establish the effect of early detection by screening on ovarian cancer mortality . Methods In this r and omised controlled trial , we recruited postmenopausal women aged 50–74 years from 13 centres in National Health Service Trusts in Engl and , Wales , and Northern Irel and . Exclusion criteria were previous bilateral oophorectomy or ovarian malignancy , increased risk of familial ovarian cancer , and active non-ovarian malignancy . The trial management system confirmed eligibility and r and omly allocated participants in blocks of 32 using computer-generated r and om numbers to annual multimodal screening ( MMS ) with serum CA125 interpreted with use of the risk of ovarian cancer algorithm , annual transvaginal ultrasound screening ( USS ) , or no screening , in a 1:1:2 ratio . The primary outcome was death due to ovarian cancer by Dec 31 , 2014 , comparing MMS and USS separately with no screening , ascertained by an outcomes committee masked to r and omisation group . All analyses were by modified intention to screen , excluding the small number of women we discovered after r and omisation to have a bilateral oophorectomy , have ovarian cancer , or had exited the registry before recruitment . Investigators and participants were aware of screening type . This trial is registered with Clinical Trials.gov , number NCT00058032 . Findings Between June 1 , 2001 , and Oct 21 , 2005 , we r and omly allocated 202 638 women : 50 640 ( 25·0 % ) to MMS , 50 639 ( 25·0 % ) to USS , and 101 359 ( 50·0 % ) to no screening . 202 546 ( > 99·9 % ) women were eligible for analysis : 50 624 ( > 99·9 % ) women in the MMS group , 50 623 ( > 99·9 % ) in the USS group , and 101 299 ( > 99·9 % ) in the no screening group . Screening ended on Dec 31 , 2011 , and included 345 570 MMS and 327 775 USS annual screening episodes . At a median follow-up of 11·1 years ( IQR 10·0–12·0 ) , we diagnosed ovarian cancer in 1282 ( 0·6 % ) women : 338 ( 0·7 % ) in the MMS group , 314 ( 0·6 % ) in the USS group , and 630 ( 0·6 % ) in the no screening group . Of these women , 148 ( 0·29 % ) women in the MMS group , 154 ( 0·30 % ) in the USS group , and 347 ( 0·34 % ) in the no screening group had died of ovarian cancer . The primary analysis using a Cox proportional hazards model gave a mortality reduction over years 0–14 of 15 % ( 95 % CI −3 to 30 ; p=0·10 ) with MMS and 11 % ( −7 to 27 ; p=0·21 ) with USS . The Royston-Parmar flexible parametric model showed that in the MMS group , this mortality effect was made up of 8 % ( −20 to 31 ) in years 0–7 and 23 % ( 1–46 ) in years 7–14 , and in the USS group , of 2 % ( −27 to 26 ) in years 0–7 and 21 % ( −2 to 42 ) in years 7–14 . A prespecified analysis of death from ovarian cancer of MMS versus no screening with exclusion of prevalent cases showed significantly different death rates ( p=0·021 ) , with an overall average mortality reduction of 20 % ( −2 to 40 ) and a reduction of 8 % ( −27 to 43 ) in years 0–7 and 28 % ( −3 to 49 ) in years 7–14 in favour of MMS . Interpretation Although the mortality reduction was not significant in the primary analysis , we noted a significant mortality reduction with MMS when prevalent cases were excluded . We noted encouraging evidence of a mortality reduction in years 7–14 , but further follow-up is needed before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening . Funding Medical Research Council , Cancer Research UK , Department of Health , The Eve Appeal Stored sample s from women in the Stockholm screening study were reassayed for CA125II ( Centocor , Malvern , PA ) and OVX1 . The postmenopausal women older than age 50 without ovarian cancer were r and omly split into a training set to develop a screening test based on longitudinal marker levels and a second set to vali date the test . The CA125II data from each woman is summarized by the slope and intercept from a linear regression of log(CAl25II ) on time since first sample . The slope versus the intercept for the training set and the ovarian cancer cases formed a bivariate scatter plot . A curve was drawn on the scatter plot that separated most of the women with ovarian cancer from all other women ; it delineated a screening test . The specificity of this test was examined on the validation set with a specificity of 99.8 % . Bayes ' theorem was used to calculate the risk of ovarian cancer ( ROC ) based on the intercept , slope , and assay variability . It is important to account for assay variability because it can produce large slopes over short periods of time . The maximum risk , which identified 83 % ( 5 of 6 ) of the ovarian cancers detected within a year of last assay , was applied as a test to the training set and confirmed a high specificity of 99.7 % . With this specificity and sensitivity , the ROC algorithm using the CA125II assay has an estimated positive predictive value of 16 % , substantially greater than the positive predictive value based on a single assay . Further study is planned to confirm the sensitivity of this approach . Cancer 1995 ; 76:2004‐10 PURPOSE Previous studies of CA-125 levels from screening trials for ovarian cancer have indicated that serial CA-125 levels may identify cases better than a fixed CA-125 cutoff . We conducted a study to assess the screening performance of the risk of ovarian cancer calculation based on serial CA-125 levels from prospect ively collected serum sample s compared with a fixed CA-125 cutoff . PATIENTS AND METHODS The calculation was applied to data from a prospect i ve trial of screening for ovarian cancer involving 22,000 postmenopausal women older than 45 years . The analysis was performed using 33,621 CA-125 results from 9,233 women for whom two or more serial sample s were available . All serum sample s from the patients with ovarian cancer were obtained before clinical detection .  Sensitivity and specificity levels for pre clinical detection of index cancers were calculated for various cutoffs for the risk and a single CA-125 measurement , and receiver operator curves were constructed . RESULTS The risk calculation significantly improved the area under the curve from 84 % to 93 % compared with a fixed cutoff for CA-125 ( P = .01 ) . For a target specificity of 98 % , the risk achieved a sensitivity of 86 % for pre clinical detection of ovarian cancer , whereas CA-125 achieved a sensitivity of 62 % . The estimates of performance are unbiased , because the risk calculation was derived independent of the data from this trial . CONCLUSION These results provide the first evidence that pre clinical detection of ovarian cancer using serial CA-125 levels interpreted with the risk calculation significantly improves screening performance compared with a fixed cutoff for CA-125 . The results justify the incorporation of the risk calculation in a prospect i ve , r and omized , controlled trial Introduction The st and ard treatment of ovarian cancer is the combination of debulking surgery and chemotherapy . There is an ongoing discussion on which treatment is best : primary debulking surgery ( PDS ) or neoadjuvant chemotherapy with interval debulking ( NACT-IDS ) . Even a large r and omized trial has not settled this issue . We examined whether comparing a specified treatment protocol would not be a more logical approach to answer this type of discussion s. Methods A retrospective study of 142 consecutively treated patients according to a fixed protocol between 2000 and 2012 was conducted .  Disease-free survival and overall survival were calculated by univariate and multivariate analyses for the whole group and for advanced stages separately . Specific differences between PDS and NACT-IDS were studied . Comparison of results from large data bases was made . Results Disease-free survival and overall 5-year survival for the whole group were 35 % and 50 % . For the advanced stages , disease-free survival and overall 5-year survival were 14 % and 36 % , with a median disease-free and overall survival of 16 and 44 months . Of the 98 women with advanced ovarian carcinoma , 54 % of operable patients underwent PDS and 44 % underwent NACT-IDS . More patients in the PDS group were optimally ( < 1 cm ) debulked : 80 % vs 71 % . There was no significant difference in survival between PDS or NACT-IDS . Optimally debulked patients had a significant better overall survival in multivariate analysis with a hazard ratio of 2.1 . Discussion Outcome of treatment according to a fixed protocol with a mixture of PDS and NACT-IDS was similar to results from large data bases . We hypothesize that comparison of a specific strategy may yield more useful results than awaiting the perfect r and omized trial BACKGROUND Ovarian cancer has a high case-fatality ratio , with most women not diagnosed until the disease is in its advanced stages . The United Kingdom Collaborative Trial of Ovarian Cancer Screening ( UKCTOCS ) is a r and omised controlled trial design ed to assess the effect of screening on mortality . This report summarises the outcome of the prevalence ( initial ) screen in UKCTOCS . METHODS Between 2001 and 2005 , a total of 202 638 post-menopausal women aged 50 - 74 years were r and omly assigned to no treatment ( control ; n=101 359 ) ; annual CA125 screening ( interpreted using a risk of ovarian cancer algorithm ) with transvaginal ultrasound scan as a second-line test ( multimodal screening [ MMS ] ; n=50 640 ) ; or annual screening with transvaginal ultrasound ( USS ; n=50 639 ) alone in a 2:1:1 ratio using a computer-generated r and om number algorithm . All women provided a blood sample at recruitment . Women r and omised to the MMS group had their blood tested for CA125 and those r and omised to the USS group were sent an appointment to attend for a transvaginal scan . Women with abnormal screens had repeat tests . Women with persistent abnormality on repeat screens underwent clinical evaluation and , where appropriate , surgery . This trial is registered as IS RCT N22488978 and with Clinical Trials.gov , number NCT00058032 . FINDINGS In the prevalence screen , 50 078 ( 98.9 % ) women underwent MMS , and 48 230 ( 95.2 % ) underwent USS . The main reasons for withdrawal were death ( two MMS , 28 USS ) , non-ovarian cancer or other disease ( none MMS , 66 USS ) , removal of ovaries ( five MMS , 29 USS ) , relocation ( none MMS , 39 USS ) , failure to attend three appointments for the screen ( 72 MMS , 757 USS ) , and participant changing their mind ( 483 MMS , 1490 USS ) . Overall , 4355 of 50 078 ( 8.7 % ) women in the MMS group and 5779 of 48 230 ( 12.0 % ) women in the USS group required a repeat test , and 167 ( 0.3 % ) women in the MMS group and 1894 ( 3.9 % ) women in the USS group required clinical evaluation . 97 of 50 078 ( 0.2 % ) women from 
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Discussion Currently , no clear recommendation for the screening for ovarian cancer in an asymptomatic population can be given based on these three studies .
The authors could not show a change in mortality using transvaginal ultrasonography for annual screening .
Conclusion An annual palpation does not offer a beneficial effect .
The development of new ultrasound machines with higher image resolution in combination with a well-st and ardized algorithm for ovarian cancer in upcoming years might provide an improvement regarding mortality .