National Center for Health Research: August 10, 2017
Comments on the USPSTF’s Draft Recommendations for Ovarian Cancer Screening
Thank you for the opportunity to express our views on the draft recommendations for ovarian cancer screening. The Cancer Prevention and Treatment Fund is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the efforts of the U.S. Preventive Services Task Force (USPSTF) to re-evaluate its 2012 grade “D” recommendation in light of new results from a large study, the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). This study confirmed that screening for ovarian cancer does not decrease deaths from ovarian cancer in asymptomatic women who are not known to be at high risk for ovarian cancer. Based on the USTSPF’s robust review of the literature, we agree that there is insufficient evidence to support screening for asymptomatic women.
Effective screening is urgently needed to reduce the number of deaths from ovarian cancer, which is estimated to exceed 14,000 in the United States this year. When ovarian cancer is treated before the cancer has spread outside the ovaries and fallopian tubes, the 5-year relative survival rate is 93%. However, the FDA warns that studies in the medical literature do not provide evidence that currently available ovarian cancer screening tests are accurate and reliable, particularly for asymptomatic women.
We agree with the USPSTF that none of the studies indicated that screening significantly reduced ovarian cancer mortality. Additionally, researchers found that the risks of screening for women are significant, including a high number of false-positive results, which can lead to unnecessary surgery and other medical complications. We agree that these significant potential risks outweigh the benefits of early detection for women with no symptoms of ovarian cancer.
In conclusion, we strongly support the USPSTF’s draft recommendation to maintain the “D” grade for ovarian cancer screening, as well as their broader efforts to improve the health of all Americans by making evidence-based recommendations about clinical preventive services. We also appreciate the attention to quality of life as an outcome of interest, as this is an important factor. As more high-quality research becomes available, we encourage the provision of additional recommendations about the benefits and harms of using new screening strategies in asymptomatic women who are not known to be at increased risk for ovarian cancer.
The USPSTF issued its final recommendation statement on February 13, 2018. The Task Force maintained its grade D recommendation, meaning it does not recommend ovarian cancer screenings in asymptomatic women.
Food and Drug Administration (2016, September 7). The FDA recommends against using screening tests for ovarian cancer screening: FDA Safety Communication. Retrieved from https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm519413.htm
National Cancer Institute: Surveillance, Epidemiology, and End Results Program. Cancer of the Ovary: 5-Year Relative Survival by Stage at Diagnosis (2007-2013). Retrieved from https://seer.cancer.gov/csr/1975_2014/browse_csr.php?sectionSEL=21&pageSEL=sect_21_table.08.html#table5
U.S. Preventive Services Task Force (2017, July). Draft Recommendation Statement. Ovarian Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement174/ovarian-cancer-screening1
U.S. Preventive Services Task Force (2018, February). Final Recommendation Statement. Ovarian Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/ovarian-cancer-screening