Ovarian Cancer

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Guideline title

Screening for Ovarian Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement

Guideline developer

US Preventive Services Task Force

Guideline year

2013

Year appraised

2013

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ovariancancersummary

OVERVIEW

This guideline1 focuses on screening for ovarian cancer in asymptomatic women. It reaffirms the 2004 statement of the U.S. Preventive Services Task Force (USPSTF)2, which recommended against screening with transvaginal ultrasonography or single-threshold serum CA-125 testing. At that time, the rationale for the recommendation was that while there was evidence that screening can detect ovarian cancer at an early stage, no trials were found that examined the effect of screening on mortality. Further, the harms of screening were high, thus outweighing any small potential mortality benefit. Since the 2004 recommendation, new evidence from a randomized controlled trial (RCT) has demonstrated that screening does not reduce mortality due to ovarian cancer.Ovarian cancer represents only 2.9% of annual new cancer diagnoses (excluding skin cancer) among Canadian women but is associated with poor 5-year survival (42%)3. Because ovarian cancer is rare in the general population, tests aimed at early detection (using transvaginal ultrasonography and CA-125 testing alone or in combination) are associated with a high false-positive rate: for every 100 women with a positive screening result, only 1 has ovarian cancer4. False-positive test results may lead to unnecessary surgery and surgical complications. Although some practitioners perform regular bimanual pelvic examination to screen for ovarian cancer, the USPSTF did not identify any RCTs that evaluated the effectiveness of this intervention on screening.

This guideline was developed in the United States by a broad range of experts and is targeted toward clinicians.

 

RELEVANCE TO CTFPHC MANDATE

All sections of this guideline are applicable to the CTFPHC mandate of prevention in primary care.

POPULATION

The target population for this recommendation is asymptomatic women without known genetic mutations that would increase the risk for ovarian cancer.

EVIDENCE REVIEW METHODS

The USPSTF last reviewed the evidence in 2008, at which point there was no new evidence addressing the benefit of screening. Therefore, the current search4 included literature published between 15 October, 2007, and 26 July, 2011, to identify “substantial evidence” (i.e., RCTs) on screening for ovarian cancer in asymptomatic women that became available since the USPSTF’s previously unpublished 2008 review. The following databases were searched: PubMed, MEDLINE and the Cochrane Central Register of Controlled Trials. Titles and abstracts of 848 articles were reviewed, the full text of 30 articles was reviewed, and the final recommendation was based on evidence from 4 articles arising from 3 RCTs.

GRADING SYSTEM

The USPSTF assigns 1 of 5 letter grades to each recommendation: A, B, C, D, or I5. These grades are based largely on the level of certainty and magnitude of the net benefit associated with providing the service.

METHODOLOGICAL QUALITY

The CTFPHC assessed the methodological quality of the guideline using the Appraisal of Guidelines Research & Evaluation (AGREE II) criteria (Table 1).This guideline scored above 60% on the domains of Scope and Purpose, Rigour of Development, and Editorial Independence; therefore, the CTFPHC has classified it as a high-quality guideline. Concordance among reviewers, as measured through standard deviation of AGREE II scores, was high (SD < 1.5) for all domains except Applicability.

Table 1. AGREE II domain scores
AGREE II domain Domain score Standard deviation
Scope and purpose 98% 0.3
Stakeholder involvement 82% 1.1
Rigour of development 90% 1.0
Clarity of development 97% 0.3
Applicability 51% 2.0
Editorial independence 83% 1.3
Overall assessment 90% 0.6

COMMENTARY

Overall, the objective, health questions and target population of this guideline are well defined and clearly presented. The recommendation statement is logical and clinically sensible, and it appears to be supported by the available evidence (although the strengths and weaknesses of the 3 included RCTs could have been better described). Despite this relatively minor concern, the guideline was rated highly by the CTFPHC through the AGREE II process and will be useful to practitioners. The guideline may need to be updated when the United Kingdom Collaborative Trial on Ovarian Cancer Screening publishes updated results (expected in 2015).

 

ORIGINAL GUIDELINE RECOMMENDATIONS

The full guideline can be found at: www.uspreventiveservicestaskforce.org.

 

  • Do not screen for ovarian cancer. (Grade D)

REFERENCES

  1. Moyer VA; U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012:157(12):900–904.
  2. U.S. Preventive Services Task Force. Screening for ovarian cancer: recommendation statement. Ann Fam Med. 2004;2(3):260–262.
  3. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian cancer statistics 2013. Toronto, ON: Canadian Cancer Society; 2013.
  4. Barton MB, Lin K. Screening for ovarian cancer: evidence update for the U.S. Preventive Services Task Force reaffirmation recommendation statement. AHRQ Publ. No. 12-05165-EF3. Rockville, Maryland: Agency for Healthcare Research and Quality; 2012.
  5. Grade definitions: grade definitions after July 2012. Rockville, Maryland: U.S. Preventive Services Task Force; 2012. Available at: <http://www.uspreventiveser vicestaskforce.org/uspstf/grades.htm>. Accessed 2013 Nov 13.

 

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