When Less is Not More: Population-level Perspective on Adnexal Cyst Surveillance for Post-Menopausal Women.

Abstract

Ovarian simple cysts are found with high frequency in older women, and at least a third eventually regress in a year. Multiple large studies, including the sample from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial, have found no direct association with ovarian cancer incidence, corroborating earlier, smaller studies [ 1 Hartge P. Hayes R. Reding D. et al. Complex ovarian cysts in postmenopausal women are not associated with ovarian cancer risk factors: preliminary data from the prostate, lung, colon, and ovarian cancer screening trial. Am J Obstet Gynecol. 2000; 183: 1232-1237 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 2 Menon U. Gentry-Maharaj A. Hallett R. et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009; 10: 327-340 Abstract Full Text Full Text PDF PubMed Scopus (631) Google Scholar ]. The current practice of safely following, rather than resecting, asymptomatic ovarian cystic lesions accompanied a rejection of an older, simple biologic model of ovarian cystic lesions as cancer precursors or markers of subsequent cancer onset in either ovary. Instead, it is now widely accepted that aggressive or high-grade ovarian neoplasms arise via a solid tumor pathway from serous tubal intraepithelial carcinoma [ 3 Erickson B.K. Conner M.G. Landen Jr., C.N. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol. 2013; 209: 409-414 Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar ]. In this decision-analytic modeling study by Pandharipande et al, the question of managing ovarian cystic lesions in postmenopausal women is revisited within the practical and highly informative context of overall health status and wide-ranging life expectancy [ 4 Seguin C.L. Lietz A.P. Wright J.D. et al. Surveillance in older women with incidental ovarian cysts: Maximal projected benefits by age and comorbidity level. J Am Coll Radiol. 2020; 18: 10-18 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity LevelJournal of the American College of RadiologyVol. 18Issue 1PreviewThe aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. Full-Text PDF