At US, ovaries were considered suspicious for malignancy if ovarian size was >4 cm and a complex morphology was apparent. In the screening group, further management ranged from annual follow-up to surgical intervention, depending on combined test results. Salient trial findings were 2-fold. First, ovarian cancer prevalence was lower (0.31/1,000) than in an expected United States population. Second, a statistically significant shift in stage distribution was not achieved. Ovarian Cancer Screening Lu, Skates, Hernandez, and Colleagues In 2013, Lu et al [22] reported results from a single-arm prospective trial of ovarian cancer screening in 4,051 postmenopausal women using the Risk of Ovarian Cancer Algorithm (ROCA) score based on serum CA-125 measurements (described below). In this trial, women with ROCA scores indicating intermediate risk (risk of ovarian cancer between 1 in 2,000 and 1 in 500) had a repeat CA-125 measurement in 3 months, and women with ROCA scores indicating elevated risk (>1 in 500) were referred for transvaginal US and gynecologic oncology consultation. After 11 years of follow-up, 10 women underwent surgery based on US findings, and 4 of these women were found to have invasive ovarian cancer (PPV, 40%). Specificity was 99.9%. These results support the notion that assessment of changing levels in biomarkers over time may be a more useful screening tool than single values, such as those used in the PLCO trial, and can improve PPV and specificity. However, this trial was not designed to assess mortality outcomes. United Kingdom Collaborative Trial of Ovarian Cancer Screening The United Kingdom Collaborative Trial of Ovarian Cancer Screening [23,24] is the largest randomized controlled trial of ovarian cancer screening to date, with over 200,000 postmenopausal women randomized to either a control group, multimodal screening (ie, annual CA-125 with transvaginal US as a follow-up test), or annual transvaginal US alone.
Ovarian Cancer Screening. At US, ovaries were considered suspicious for malignancy if ovarian size was >4 cm and a complex morphology was apparent. In the screening group, further management ranged from annual follow-up to surgical intervention, depending on combined test results. Salient trial findings were 2-fold. First, ovarian cancer prevalence was lower (0.31/1,000) than in an expected United States population. Second, a statistically significant shift in stage distribution was not achieved. Ovarian Cancer Screening Lu, Skates, Hernandez, and Colleagues In 2013, Lu et al [22] reported results from a single-arm prospective trial of ovarian cancer screening in 4,051 postmenopausal women using the Risk of Ovarian Cancer Algorithm (ROCA) score based on serum CA-125 measurements (described below). In this trial, women with ROCA scores indicating intermediate risk (risk of ovarian cancer between 1 in 2,000 and 1 in 500) had a repeat CA-125 measurement in 3 months, and women with ROCA scores indicating elevated risk (>1 in 500) were referred for transvaginal US and gynecologic oncology consultation. After 11 years of follow-up, 10 women underwent surgery based on US findings, and 4 of these women were found to have invasive ovarian cancer (PPV, 40%). Specificity was 99.9%. These results support the notion that assessment of changing levels in biomarkers over time may be a more useful screening tool than single values, such as those used in the PLCO trial, and can improve PPV and specificity. However, this trial was not designed to assess mortality outcomes. United Kingdom Collaborative Trial of Ovarian Cancer Screening The United Kingdom Collaborative Trial of Ovarian Cancer Screening [23,24] is the largest randomized controlled trial of ovarian cancer screening to date, with over 200,000 postmenopausal women randomized to either a control group, multimodal screening (ie, annual CA-125 with transvaginal US as a follow-up test), or annual transvaginal US alone.