Ovarian cancer screening

Abstract

Ovarian cancer is the most common gynaecological malignancy in the developed world. It also carries the worst prognosis with an overall 5-year survival of 30%. This is likely to be due to the disease frequently presenting late, the ovary position within the peritoneal cavity resulting in minimal local irritation, or interference with vital structures until ovarian enlargement is considerable, or metastasis occurs. Seventy per cent of women are diagnosed with stage III or IV disease, with 5-year survivals of 15–20% and less than 5%, respectively[1]. Despite an increase in understanding of the molecular events underlying malignancy, and advances in both surgery and chemotherapy, the overall prognosis of ovarian cancer has changed little over the last 30 years. However, women who are diagnosed at an early stage do have a significantly improved prognosis, with survival of above 80% in stage I disease, and above 90% in those diagnosed at stage Ia[2]. The best way of improving outcome may be, therefore, to detect the condition at an early stage, when the prognosis remains relatively good, via a screening programme. This is an exciting prospect and screening trials have shown some encouraging results. However, as yet screening has not been shown conclusively to reduce mortality from ovarian cancer. In addition, our lack of knowledge about disease progression and of primary peritoneal cancer, as well as the possible surgical and psychological morbidity that may result from screening, should be considered. There are also, of course, cost implications.