Avoid ovarian cancer tests

Tests commonly recommended to screen healthy women for ovarian cancer do more harm than good and should not be performed, a panel of medical experts said Monday.

The screenings -- blood tests for a substance linked to cancer, and ultrasound scans to examine the ovaries -- do not lower the death rate from the disease, and they yield many false-positive results that lead to unnecessary operations with high complication rates, the panel said.

"There is no existing method of screening for ovarian cancer that is effective in reducing deaths," said Dr. Virginia Moyer, chairwoman of the expert panel, the U.S. Preventive Services Task Force. "In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery."

The advice against testing applies only to healthy women with an average risk of ovarian cancer, not to those with suspicious symptoms or those at high risk because they carry certain genetic mutations or have a family history of the disease.

Other tests rejected, too
The recommendations are just the latest in a series of challenges to cancer screenings issued by the panel, which has also rejected routine PSA screenings for prostate cancer in men and routine mammograms in women younger than 50. The task force is a group of 16 experts, appointed by the government but independent, that makes recommendations about screening tests and other efforts to prevent disease. Its advice is based on medical evidence, not cost.

The recommendations against screening for ovarian cancer were published Monday in Annals of Internal Medicine. The warning is not new -- the panel is reaffirming its own earlier advice.

Although the task force has sometimes drawn fire in the past, particularly with its stand on mammograms, in this case it has plenty of support. Other medical groups, including the American Cancer Society and the American Congress of Obstetricians and Gynecologists, have for years been discouraging tests to screen for ovarian cancer.

But some doctors continue to recommend screening anyway, and patients request it, clinging to the mistaken belief that the tests can somehow find the disease early enough to save lives. A report published in February in Annals of Internal Medicine, based on a survey of 1,088 doctors, said that about a third of them believed the screening was effective and that many routinely offered it to patients. "We are fueled by hope," Moyer said.

Ovarian cancer is among the more rapidly fatal forms of cancer. This year, 22,280 new cases and 15,500 deaths are expected in the United States, according to the American Cancer Society.

In most cases, ovarian cancer is already advanced by the time it is diagnosed. Doctors say the only advice they can give women is not to ignore symptoms that may be the first warning of the disease: persistent bloating, pelvic or abdominal pain, feeling full early while eating and needing to urinate frequently.

For its latest recommendations, the panel relied heavily on a large study published last year in the Journal of the American Medical Association of 78,216 women from ages 55 to 74. Half were screened and half not, and they were followed for 11 to 13 years. The screening consisted of ultrasound exams and blood tests for elevated levels of a substance called CA-125, which can be a sign of ovarian cancer.

Many false positives
The death rate from ovarian cancer was the same in the two groups. But among the women who were screened, nearly 10 percent -- 3,285 women -- had false positive results. Of those women with false positives, 1,080 had surgery, usually to remove one or both ovaries. Only after the operations were done was it clear that they had been unnecessary. And at least 15 percent of the women who had surgery had at least one serious complication.

To find one case of ovarian cancer, 20 women had to undergo surgery.

By DENISE GRADY @ New York Times

Ovarian Cancer Women Have a Slightly Higher Risk

Obesity is also a risk factor among women who have never taken HRT, say international researchers.

Previous studies have suggested a link, but there has been conflicting evidence.

The latest research, published in the journal PLoS Medicine, analysed all worldwide data on the topic.

It looked at 47 epidemiological studies in 14 countries, including about 25,000 women with ovarian cancer and more than 80,000 women without ovarian cancer.

Lead researcher Prof Valerie Beral of the Oxford University Epidemiology Unit told the BBC: "By bringing together the worldwide evidence, it became clear that height is a risk factor."

She said there was also a clear relationship between obesity and ovarian cancer in women who had never taken HRT.

"Ovarian cancer can clearly be added to the list [of cancers linked to obesity]," she added.

Sarah Williams, health information officer at Cancer Research UK, said the study produced a clearer picture of the factors that could affect a woman's risk of developing ovarian cancer, and found that body size was important.

"Women can reduce their risk of this and many other diseases by keeping to a healthy weight," she said.

"For women trying to lose weight, the best method is to eat healthily, eat smaller amounts and be more physically active."

Commenting on the study, Dr Paul Pharoah, reader in cancer epidemiology at the University of Cambridge, said the increase in risk was small.

"If we compare a woman who is 5ft tall with a woman who is 5ft 6in tall, there is a relative difference in ovarian cancer risk of 23%.

"But the absolute risk difference is small. The shorter woman will have a lifetime risk of about 16-in-a-1000 which increases to 20-in-a-1000 for the taller woman.

"A similar difference in absolute risk would be seen when comparing a slim woman with a body mass index of 20 to a slightly overweight woman with a body mass index of 30."

The findings

• A slight increase in the risk of developing ovarian cancer for every 5cm increase in height (taking into account other factors such as age, smoking, and alcohol consumption)
• A slight increase in the risk of ovarian cancer with higher BMI, in women who have never taken hormone replacement therapy (HRT)

By: Helen Briggs

Clinic in Greenup will offer free ovarian cancer screenings for Northeast Ky. women

Women in Northeastern Kentucky will be able to receive free ovarian cancer screenings thanks to funding that will set up a clinic in Greenup County.

The clinic is intended for women in Lewis, Carter, Elliott, Greenup and Boyd counties, as well as two counties in Ohio, but "certainly anyone who arrives at the clinic who meets the requirements will be eligible for screening," said Parry Barrows, spokeswoman for Gov. Steve Beshear's office. Eligible women must be age 50 and older or over the age of 25 who have a family history of ovarian cancer.

The clinic will be an expansion of a program that has been in place in Lexington since 1987. As of September, more than 200,000 screenings have been performed on more than 37,000 Kentucky women as part of the program.

To build the clinic, which will be located in the Greenup County Health Department, a $200,000 Appalachian Regional Commission grant will be combined with $45,000 from UK. The health department will contribute $66,600.

"Funding will go toward purchasing required equipment and furnishings, as well as provide program operations for up to 3 years," saysa press release from Beshear's office. "UK will train local ultrasound technicians to facilitate the scans and the UK Markey Cancer Center will read the scans and deliver patient reports."

"Establishing this satellite clinic ... will help save lives by giving women in northeast Kentucky and southern Ohio better access to free ovarian cancer screenings," said Chris Crum, director of the Greenup County Health Department. (Read more)