Screening for ovarian cancer did not reduce early deaths

A trial of annual screening tests for ovarian cancer in more than 200,000 volunteers aged 50 to 74 without symptoms, found that early deaths were not reduced at 16 years follow-up. The UK Collaborative Trial of Ovarian Cancer Screening randomly assigned half of the volunteers to a control group and the other half equally to annual screening with ultrasound for examination of the pelvis or with a blood test for CA125 to be followed by ultrasound if CA125 had increased.

At the average follow-up of 16 years 2,055 women had developed tubal or ovarian cancer. The diagnosis had been made in 1% of those in each of the two screening groups and also in 1% of the group not screened. Those screened with CA125 were diagnosed when their cancers were at an earlier stage than those in the other two groups. However, the latest follow-up analysis at 5 years after screening ended (published online in The Lancet on 12 May 2021) found that 0.6% of women had died of the disease in each of the three groups. The researchers concluded: ‘Given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended’.

Professor Mahesh Parmar, Director of the MRC Clinical Trials Unit at University College London and a senior author of the paper, said: ‘Our trial showed that screening was not effective in women who do not have any symptoms of ovarian cancer; in women who do have symptoms early diagnosis, combined with better treatment, can still make a difference to quality of life and, potentially, improve outcomes’.

Non-specific symptoms suggestive of ovarian cancer include persistent or recurrent abdominal bloating, loss of appetite, abdominal pain, altered bowel frequency or stool form, or the need to pass urine frequently or urgently. In April 2011 the National Institute for Health and Care Excellence (NICE) recommended that General Practitioners should offer a blood test for CA125 to women with such symptoms and, if it is raised, should arrange ultrasound examination.