In 2016, Lai et al [36] published a subgroup analysis of PLCO data to determine whether annual screening with pelvic US and serum CA-125 reduced ovarian cancer mortality in a subgroup of women with a first-degree relative with breast or ovarian cancer. The authors compared outcomes for 11,293 women in the screening group and 11,062 women in the control group, who were followed for a minimum of 10 years. As seen in the parent PLCO study, there was no significant difference in ovarian cancer mortality between the screening and control groups. There was evidence of a stage shift and improved survival among patients with ovarian cancer in the screening group (relative risk, 0.66; 95% CI, 0.47-0.93). The authors acknowledged the potential for standard epidemiologic biases to affect their results, despite specific methodologic measures taken, and emphasized the need for further related investigation in high-risk individuals. MRI To our knowledge, there are no trials for the use of MRI as an ovarian cancer screening tool in high-risk women. MRI is unlikely to be investigated as a screening tool. CT To our knowledge, there are no trials of the use of CT as an ovarian cancer screening tool in high-risk women. CT has a limited role in the evaluation of adnexal lesions and would be an impractical screening modality because of its poor discriminatory ability between benign and malignant adnexal lesions and the associated risks of ionizing radiation. Ovarian Cancer Screening FDG-PET/CT To our knowledge, there are no trials of the use FDG-PET/CT as an ovarian cancer screening tool in high-risk women. FDG-PET/CT has poor performance in this setting and is impractical as a screening modality. Summary of Recommendations Ovarian cancer screening is not recommended for average-risk premenopausal women. Ovarian cancer screening is not recommended for average-risk postmenopausal women, as randomized controlled trials have not demonstrated a definitive mortality benefit in this population.
Ovarian Cancer Screening. In 2016, Lai et al [36] published a subgroup analysis of PLCO data to determine whether annual screening with pelvic US and serum CA-125 reduced ovarian cancer mortality in a subgroup of women with a first-degree relative with breast or ovarian cancer. The authors compared outcomes for 11,293 women in the screening group and 11,062 women in the control group, who were followed for a minimum of 10 years. As seen in the parent PLCO study, there was no significant difference in ovarian cancer mortality between the screening and control groups. There was evidence of a stage shift and improved survival among patients with ovarian cancer in the screening group (relative risk, 0.66; 95% CI, 0.47-0.93). The authors acknowledged the potential for standard epidemiologic biases to affect their results, despite specific methodologic measures taken, and emphasized the need for further related investigation in high-risk individuals. MRI To our knowledge, there are no trials for the use of MRI as an ovarian cancer screening tool in high-risk women. MRI is unlikely to be investigated as a screening tool. CT To our knowledge, there are no trials of the use of CT as an ovarian cancer screening tool in high-risk women. CT has a limited role in the evaluation of adnexal lesions and would be an impractical screening modality because of its poor discriminatory ability between benign and malignant adnexal lesions and the associated risks of ionizing radiation. Ovarian Cancer Screening FDG-PET/CT To our knowledge, there are no trials of the use FDG-PET/CT as an ovarian cancer screening tool in high-risk women. FDG-PET/CT has poor performance in this setting and is impractical as a screening modality. Summary of Recommendations Ovarian cancer screening is not recommended for average-risk premenopausal women. Ovarian cancer screening is not recommended for average-risk postmenopausal women, as randomized controlled trials have not demonstrated a definitive mortality benefit in this population.