Ovarian cancer screening: Still waiting for the right answer

Abstract

We open this issue with a position statement from the National Breast and Ovarian Cancer Centre on the current state of play in ovarian cancer screening in asymptomatic women. Essentially they argue that none of the methods which have been studied are of sufficient value for them to be recommended. It is a depressing thought that there is still no method of early detection that can be used in such a population of women, for a disease whose prognosis depends substantially on the stage at presentation which is often very late. However, it is also very important to appreciate the possibility of causing harm by using screening tests whose specificity is very low – false positive results can lead to enormous anxiety and in some cases, unnecessary interventions including surgery. The use of screening tests in this regard needs to be evidence-based and at this time, the evidence does not support their use. On the obstetric side I have accepted for publication two articles on the use of Kjelland's forceps. I make no secret of the fact that I am a strong advocate for this instrument and am fortunate to work in a unit where many of our specialists are quite expert in their use. The two papers show an interesting paradox. While there is reasonably good evidence from an audit of outcomes that they can be used safely, the survey of trainee's shows that very few are getting much experience in their use and virtually none will use them when in practice. So the inevitable conclusion is that this is likely to be the last generation of obstetricians who use them. I do feel sad for the next generation who will never experience that satisfying feeling of overcoming a malposition with a gentle touch, and the joy in the mother's eyes when she knows that the obstruction has been easily overcome. At the end of my last Editorial I mentioned that the latest Impact Factor (IF) for ANZJOG had shown a significant rise and that for the first time ever we had achieved an IF of greater than 1. The gradual improvement in quality that this reflects is only achieved by many people who contribute to our success. Those who submit their work, the Editorial Board and the reviewers all play their part in ensuring that the articles that we publish in each issue are read more widely and then cited. I'd like to thank all of you who have helped us to reach this important milestone. Now let's aim for greater than 2! Finally, there is a very sad story behind one of the papers in this issue. We are publishing an interesting case series of caesarean scar pregnancies from Western Australia, completed as a trainee's research project. Sadly, on 24 July 2009 the tragic death of Dr Camille Michener, the first author, occurred in a motor vehicle accident in rural Western Australia. Camille was a third year RANZCOG trainee. After obtaining her medical training in Victoria, she located to Western Australia where she commenced her training in obstetrics and gynaecology. Always an advocate for ongoing improvements in medical training and working conditions, Camille lobbied vigorously in the medical practitioners’ safe working hours debate for the Australian Medical Association. She was elected as the President of the Doctors in Training Program in Western Australia in 2007. Camille was a dedicated medical practitioner and her passing is a great loss to the medical profession and the women of Australia. She will be greatly missed by her friends and colleagues at King Edward Memorial Hospital and our thoughts and prayers go to her family for their sad loss.