The latest evidence does not support any tests or combination of tests for screening or surveillance of ovarian cancer.
Ovarian cancer has been called a ‘silent killer’, as it tends to either have no symptoms or symptoms that can easily be interpreted as other, less malign health issues. This can make it hard to detect the disease early and provide the best possible chance for patient treatment.
‘Unfortunately, survival rates [of ovarian cancer], although they have improved over the past 20 years, still remain low at 45.7% five-year relative survival,’ Cancer Australia Chief Executive Dr Helen Zorbas told newsGP.
‘So there is a great interest amongst women and health professionals to not miss the disease and diagnose it early.’
To mark Ovarian Cancer Awareness Month, Cancer Australia has released its updated position statement, ‘Testing for ovarian cancer in asymptomatic women’. This represents the statement’s first update in 10 years and incorporates the latest evidence in the field, much of which has been focused on whether there is a feasible option for screening or surveillance testing for ovarian cancer.
‘It was considered important to review the evidence and to provide up-to-date guidance, particularly to GPs who are at the frontline of women who may be concerned about risk of ovarian cancer, or who may be hearing about the disease and want to understand how to be screened for it,’ Dr Zorbas explained.
On the basis of this evidence, the advice in the position statement further underlines that of its 2009 predecessor; however, Dr Zorbas believes this is just as important to publicise as would be the fact of a new test or procedure.
‘I guess it’s regrettable we don’t have a better news story, if you like. But, importantly, they’re very clear recommendations to guide women and health professionals in relation to the lack of evidence to support the use of any particular test or combination of tests to reduce mortality from ovarian cancer,’ Dr Zorbas said.
‘So not as a screening test or an early detection test for women at population risk, or even for women at potentially high risk of ovarian cancer.’
Cancer Australia Chief Executive Dr Helen Zorbas wants to provide GPs with up-to-date, evidence-based recommendations on identifying and testing for ovarian cancer.
Part of the reason such testing for the purposes of surveillance or screening is not feasible is that many current procedures are very invasive.
‘For example, a potential positive finding on one of those tests as a diagnosis for ovarian cancer would require removal of an ovary – surgery so that tissue could be examined,’ Dr Zorbas said.
‘Therefore, there are significant risks associated with such procedures and we would need to have strong evidence of a survival benefit to justify women undergoing them.’
Dr Zorbas believes the lack of screening or surveillance testing is especially important to emphasise, as knowledge among the public about how to detect ovarian cancer has not kept pace with awareness of the disease itself.
‘Even well-educated and well-versed women still confuse the idea of the cervical screening test and the detection of cervical cancer with the detection of ovarian cancer as well, and of course it does not have a role in detecting ovarian cancer,’ she said.
Dr Zorbas confirmed that the current advice for GPs is to focus on symptoms.
‘If there are symptoms, it’s really important to have them investigated early and appropriately; there are algorithmsGPs can follow in terms of the appropriate investigation of symptoms that could be ovarian cancer,’ she said.
It is also very important to investigate women with a strong family history risk.
‘For women who have a family history of either ovarian cancer, breast cancer or colon cancer, because of Lynch Syndrome: if they’ve got particularly close relatives who have had those cancers at an age under 60, or, any blood relative on the same side of the family with ovarian cancer, particularly if there’s more than one blood relative, that’s really important history to report to the GP to have an assessment of family history,’ Dr Zorbas said.
‘If it’s then deemed appropriate, based on that potential high risk, it is important to have that assessment more accurately undertaken through a cancer clinic.
‘Because the women at high risk for family cancer, particularly if they’ve got a faulty gene in the BRCA1 on BACA2 or Lynch Syndrome gene, could potentially benefit greatly from discussing and undertaking risk-reducing surgery which would be removal of the ovaries and fallopian tubes, and they should really seek advice around these options in order to make an informed decision in their particular circumstances.’
However, Dr Zorbas re-emphasised the fact there is no evidence to support routine testing in asymptomatic women, regardless of whether they have a family history of the disease.
‘There are a number of tests that have been studied; a CA 125, or a transvaginal ultrasound, or combination of tests – none of those have been found to actually impact on mortality from the disease in asymptomatic women,’ she said.