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Breast and Ovarian Cancer
  Screening Procedures for
Ovarian Cancer

By Kari Danziger, MS, CGC

Reviewed by Beth Crawford, MS, CGC and Miriam Komaromy, MD


 

Doctors use two procedures for detecting early signs of ovarian cancer. However, neither of these screening methods is considered to be accurate enough for use in the general population. Instead, they are primarily used in women who have a family history of ovarian cancer or who have a known or suspected mutation in one of the genes that are known to increase a woman's risk of ovarian cancer.

 
 
Difficulties Associated With Ovarian Cancer Screening
 For an ovarian cancer screening test to be useful, it must be:
  • Simple to perform
  • Specific enough to identify those who don't have the disease
  • And most importantly, sensitive enough to detect almost everyone who does have the disease.

In other words, a test that overlooks symptoms in some individuals or that falsely identifies them in others is not appropriate for the general population. There is simply too much room for error — especially if that error can lead someone to believe that he or she is cancer-free. In such cases, the outcome can be disastrous.

Because there is no ovarian screening test that meets these criteria, there are no screening methods for ovarian cancer that are practical for the general population. However, for women who are at increased risk of ovarian cancer, two screening tools are available. These include transvaginal ultrasonography (a procedure to view the ovaries) — which is also sometimes used with a technique called Doppler (which evaluates blood flow) — and measurement of CA-125 levels (a chemical found in the bloodstream that may be elevated when an ovarian tumor is present).

Neither of these tests are 100 percent accurate, which is why they are not appropriate or recommended for the general population. However, ovarian cancer often fails to produce symptoms until it is advanced and has spread to other organs. So, even a test that is not totally accurate is preferable to no test at all in women who are at very high risk for the disease, if it can give the patient and the physician an indication that cancer might be developing. However, it is important to keep in mind that even in high risk women these tests have not be proven to help the women live longer.

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Pelvic Examination
Doctors often perform a pelvic exam on women during their annual check up. Although a pelvic exam can occasionally detect ovarian cancer, it often misses cancers or only detects the cancer when it is quite advanced and harder to treat. In addition, abnormalities found during pelvic exams often do not turn out to be cancer. For these reasons, pelvic exams are not considered an effective screening method for ovarian cancer. However, they are an important part of an annual exam because they allow the physician to perform a pap smear to screen for cervical cancer.

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Transvaginal Ultrasound With Color Doppler

In this procedure, a doctor inserts a small probe that produces sound waves in the vagina. The ultrasound waves create an image of the ovaries on a computer screen, enabling physicians to detect signs of ovarian cancer. By adding color doppler, doctors can see detail about blood flow in the tissue. Although this is the best single tool for ovarian cancer screening, it's far from perfect. It can fail to detect a developing tumor and can also mistakenly identify a noncancerous lesion as a tumor.

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CA-125 Testing

In this procedure, doctors look for a chemical, or tumor marker called CA-125 in a woman's bloodstream. Because ovarian cancers usually produce CA-125, an above-average level can be an indicator of ovarian cancer. However, CA-125 testing is far from the perfect screening method because:

  • More than 50 percent of early-stage tumors fail to produce elevated CA-125 levels, meaning that CA-125 levels can remain low even when cancer is present.
  • Some benign conditions can lead to elevated CA-125 levels, including pregnancy, pelvic inflammatory disease, tuberculosis, and cirrhosis of the liver.

It is more accurate to establish a baseline CA-125 test and then compare future tests with the woman's own previous test results. However, in women age 50 or older, it appears to be better for distinguishing between benign and malignant conditions.

References


Gargano, G. et al. (1990). The role of tumour markers in ovarian cancer. Clin Exp Obstet Gynecol. 17(1):23-9.

Higgins, R.V. et al. (1989). Transvaginal sonography as a screening method for ovarian cancer. Gynecol Oncol. 34(3):402-6.

van Nagell, Jr. et al. (1990). Transvaginal sonography as a screening method for ovarian cancer. A report of the first 1000 cases screened. Cancer. 65(3):573-7.


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