Ultrasound screening for ovarian cancer: high cost and low precision.

“Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening”

Obstetrics and Gynecology 132(5):1089-1090, November 2018

 “The University of Kentucky Ovarian Cancer Screening Trial was initiated in 1987 to determine the effect of annual trans vaginal ultrasonography on stage at detection and ovarian cancer mortality.  Since that time, free screening has been provided to more than 46,000 women (at high risk due to familial factors). 

Unscreened women with clinically detected epithelial ovarian cancer referred to the University of Kentucky-Markey Cancer Center for treatment from 1995 to 2017 served as the control group for this investigation.

Women who had a normal screen were scheduled to return in 12 months for a repeat screen. Women who had an abnormal screen underwent a repeat ultrasound examination in 4–6 weeks. Criteria for abnormality included an ovarian volume greater than 20cm³for premenopausal women and greater than 10 cm³ for postmenopausal women. 

A total of 699 women (1.5%) with persisting ovarian tumors on trans vaginal ultrasonography underwent surgery. Seventy-one women with invasive epithelial ovarian cancer were detected. (Precision 0.101)

Twenty-six women (37%) in the screening group had stage III ovarian cancer at the time of detection as compared with 70% of women in the unscreened group with stage III or IV.  The 10-year ovarian cancer mortality was reduced in women receiving screening by 31% and produced 416 life years gained at a cost of $40,851 per life year gained”. ($17M)