Screening Recommendations for Ovarian Cancer

Women currently get screened for ovarian cancer using manual examination of the ovaries at the time of a Pap test. This is recommended. What’s not recommended for the average person is a serum marker screening test for ovarian cancer or an ultrasound done every few years. Other than manual exam, no screening test exists for average risk women with no history of ovarian disease. Screening only leads to unnecessary follow up tests and worries on the part of the woman having the tests. There are too many false positives in these tests.

If, on the other hand, there are suspicions for ovarian cancer, such as abdominal bloating, fatigue, inability to eat well, urinary frequency, indigestion, abdominal pain, constipation, pelvic pain or unexplained weight loss, then an ultrasound is warranted.

Woman at a decreased risk for ovarian cancer include those who have been on oral contraceptive pills for many years. Even a single year of oral contraceptives has been found to be protective for up to nineteen years after stopping the pills. It’s a good idea to counsel women on the benefit of oral contraceptives at the time they start taking them.

Women at an increased risk of ovarian cancer are those with a family history of the BRCA mutations in their genes. These are the same mutations seen in breast cancer patients. If a woman has had a first degree relative with ovarian cancer before aged 40, she is at higher risk herself. If a first degree relative has had ovarian cancer before aged 50 are at lesser risk but still are at higher risk. The more first and second degree relatives with ovarian cancer, the higher is the risk of having a brca mutation. Such a woman should be evaluated for this condition and then should have annual trans-vaginal ultrasounds with or without an evaluation of the CA-125 serum marker. The CA-125 serum marker has been found to be associated with some types of ovarian cancer.

The problem with the brca screening test is that it is around $3000 US dollars, meaning it makes a very poor screening test or the average population. It is only recommended for those who are considered high risk for ovarian cancer by family history. A CA-125 screening test is actually not good for screening for ovarian cancer because some ovarian cancers do not release CA-125. If it is found to be elevated, however, it is a good way to track the progress of the cancer and to make sure the numbers stay low after ovarian cancer treatment.