***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: CONTEXT Screening for ovarian cancer with cancer antigen 125 ( CA-125 ) and transvaginal ultrasound has an unknown effect on mortality . OBJECTIVE To evaluate the effect of screening for ovarian cancer on mortality in the Prostate , Lung , Colorectal and Ovarian ( PLCO ) Cancer Screening Trial . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of 78,216 women aged 55 to 74 years assigned to undergo either annual screening  ( n = 39,105 ) or  usual care  ( n = 39,111 ) at 10 screening centers across the United States between November 1993 and July 2001 . Intervention The intervention group was offered annual screening with CA-125 for 6 years and transvaginal ultrasound for 4 years . Participants and their health care practitioners received the screening test results and managed evaluation of abnormal results . The usual care group was not offered annual screening with CA-125 for 6 years or transvaginal ultrasound but received their usual medical care . Participants were followed up for a maximum of 13 years ( median [ range ] , 12.4 years [ 10.9 - 13.0 years ] ) for cancer diagnoses and death until February 28 , 2010 . MAIN OUTCOME MEASURES Mortality from ovarian cancer , including primary peritoneal and fallopian tube cancers . Secondary outcomes included ovarian cancer incidence and complications associated with screening examinations and diagnostic procedures . RESULTS Ovarian cancer was diagnosed in 212 women ( 5.7 per 10,000 person-years ) in the intervention group and 176 ( 4.7 per 10,000 person-years ) in the usual care group ( rate ratio [ RR ] , 1.21 ; 95 % confidence interval [ CI ] , 0.99 - 1.48 ) . There were 118 deaths caused by ovarian cancer ( 3.1 per 10,000 person-years ) in the intervention group and 100 deaths ( 2.6 per 10,000 person-years ) in the usual care group ( mortality RR , 1.18 ; 95 % CI , 0.82 - 1.71 ) . Of 3285 women with false-positive results , 1080 underwent surgical follow-up ; of whom , 163 women experienced at least 1 serious complication ( 15 % ) . There were 2924 deaths due to other causes ( excluding ovarian , colorectal , and lung cancer ) ( 76.6 per 10,000 person-years ) in the intervention group and 2914 deaths ( 76.2 per 10,000 person-years ) in the usual care group ( RR , 1.01 ; 95 % CI , 0.96 - 1.06 ) . CONCLUSIONS Among women in the general US population , simultaneous screening with CA-125 and transvaginal ultrasound compared with usual care did not reduce ovarian cancer mortality . Diagnostic evaluation following a false-positive screening test result was associated with complications . Trial Registration clinical trials.gov Identifier : NCT00002540 BACKGROUND No professional society or group recommends routine ovarian cancer screening , yet physicians ' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms . OBJECTIVE To provide nationally representative estimates of physicians ' reported nonadherence to recommendations against ovarian cancer screening . DESIGN Cross-sectional survey of physicians offering women 's primary care . The 12-page question naire contained a woman 's annual examination vignette and questions about offers or orders for transvaginal ultrasonography ( TVU ) and cancer antigen 125 ( CA-125 ) . SETTING United States . PARTICIPANTS 3200 physicians r and omly sample d equally from the 2008 American Medical Association Physician Masterfile lists of family physicians , general internists , and obstetrician-gynecologists ; 61.7 % responded . After exclusions , 1088 respondents were included ; their responses were weighted to represent the specialty distribution of practicing U.S. physicians nationally . MEASUREMENTS Reported nonadherence to screening recommendations ( defined as sometimes or almost always ordering screening TVU or CA-125 or both ) . RESULTS Twenty-eight percent ( 95 % CI , 24.5 % to 32.9 % ) of physicians reported nonadherence to screening recommendations for women at low risk for ovarian cancer ; 65.4 % ( CI , 61.1 % to 69.4 % ) did so for women at medium risk for ovarian cancer . Six percent ( CI , 4.4 % to 8.9 % ) reported routinely ordering or offering  ovarian cancer screening  for low-risk women , as did 24.0 % ( CI , 20.5 % to 28.0 % ) for medium-risk women ( P ≤ 0.001 ) . Thirty-three percent believed TVU or CA-125 was an effective screening test . In adjusted analysis , actual and physician-perceived patient risk , patient request for ovarian cancer screening , and physician belief that TVU or CA-125 was an effective screening test were the strongest predictors of physician-reported nonadherence to published recommendations . LIMITATION The results are limited by their reliance on survey methods ; there may be respondent-nonrespondent bias . CONCLUSION One in 3 physicians believed that ovarian cancer screening was effective , despite evidence to the contrary . Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening , thereby exposing women to the documented risks of these tests . PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention and the National Cancer Institute 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 the MMS group and 845 of 48 230 ( 1.8 % ) from the USS group underwent surgery . 42 ( MMS ) and 45 ( USS ) primary ovarian and tubal cancers were detected , including 28 borderline tumours ( eight MMS , 20 USS ) . 28 ( 16 MMS , 12 USS ) of 58 ( 48.3 % ; 95 % CI 35.0 - 61.8 ) of the invasive cancers were stage I/II , with no difference ( p=0.396 ) in stage distribution between the groups . A further 13 ( five MMS , eight USS ) women developed primary ovarian cancer during the year after the screen . The sensitivity , specificity , and positive-predictive values for all primary ovarian and tubal cancers were 89.4 % , 99.8 % , and 43.3 % for MMS , and 84.9 % , 98.2 % , and 5.3 % for USS , respectively . For primary invasive epithelial ovarian and tubal cancers , the sensitivity , specificity , and positive-predictive values were 89.5 % , 99.8 % , and 35.1 % for MMS , and 75.0 % , 98.2 % , and 2.8 % for USS , respectively . There was a significant difference in specificity ( p<0.0001 ) but not sensitivity between the two screening groups for both primary ovarian and tubal cancers as well as primary epithelial invasive ovarian and tubal cancers . INTERPRETATION The sensitivity of the MMS and USS screening strategies is encouraging . Specificity was higher in the MMS than in the USS group , result ing in lower rates of repeat testing and surgery . This in part reflects the high prevalence of benign adnexal abnormalities and the more frequent detection of borderline tumours in the USS group . The prevalence screen has established that the screening strategies are feasible . The results of ongoing screening are awaited so that the effect of screening on mortality can be determined BACKGROUND The performance characteristics of serum prostate-specific antigen ( PSA ) as a diagnostic test for prostate cancer ( PCa ) are poor . The performance of the PCa antigen 3 ( PCA3 ) gene as a primary diagnostic is unknown . OBJECTIVE Assess the value of PCA3 as a first-line diagnostic test . DESIGN , SETTING AND PARTICIPANTS Participants included men aged 63 - 75 who were invited for rescreening in the period from September 2007 to February 2009 within the European R and omised Study of Screening for Prostate Cancer , Rotterdam section . INTERVENTIONS Lateral sextant biopsies were performed if the serum PSA value was > or = 3.0 ng/ml and /or the PCA3 score was > or = 10 . MEASUREMENTS Measurements included distribution and correlation of PSA value and PCA3 score and their relation to the number of cases and the characteristics of PCa detected . Additional value of PCA3 was included in men with previous negative biopsy and /or PSA < 3.0 ng/ml . RESULTS AND LIMITATIONS In 721 men , all biopsied , 122 PCa cases ( 16.9 % ) were detected . Correlation between PSA and PCA3 is poor ( Spearman rank correlation : ρ=0.14 ; p<0.0001 ) . A PSA > or = 3.0 ng/ml misses 64.7 % of the total PCa that can be detected with the sextant biopsy technique and 57.9 % of serious PCa ( T2a or higher and /or Gleason grade > or = 4 , n=19 ) , and 68.2 % of biopsies could have been avoided ; the respective data for PCA3 > or = 35 are 32 % , 26.3 % , and 51.7 % . Performance of PCA3 in men with low PSA ( area under the curve [ AUC ] : 0.63 ) and /or previous negative biopsy ( AUC : 0.68 ) is unclear but has limited reliability due to small numbers . CONCLUSIONS PCA3 as a first-line screening test shows improvement of the performance characteristics and identification of serious disease compared with PSA in this prescreened population 
    Output:
    
Screening compared with usual care did not reduce ovarian cancer mortality .
Patient harms included overdiagnosis and false-positive results .
Although ovarian cancer screening with CA125 showed no benefit , false-positive tests , overdiagnosis and overtreatment were reported .