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Case History

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Image not available. A 35-year-old woman's mother died at age 49 years from epithelial ovarian cancer. There is no other family history of cancer. She wants to be counselled with regard to ovarian cancer screening.

Who should be screened, and what constitutes high risk?

What is the most appropriate screening method?

At what age should screening commence, and what is the most appropriate screening interval?

Is screening the best way to manage risk, and what are the alternatives?

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Background

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Who should be screened, and what constitutes high risk?

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Image not available. Ovarian cancer is responsible for more deaths per year in the industrialized world than cervical and endometrial cancer combined. The poor prognosis for women with ovarian cancer is related to the fact that the disease is usually diagnosed at an advanced stage. By the time the patient develops symptoms and is investigated, the disease has usually progressed and chances of cure are minimal. Therefore great interest exists in early detection of ovarian cancer through screening in asymptomatic women.

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Screening for ovarian cancer, however, is hampered by (a) the low incidence of ovarian cancer in the general population, (b) the lack of identification of an ovarian cancer precursor lesion and pre-clinical asymptomatic disease, and (c) the lack of sufficient sensitivity and specificity of established screening tests (serum CA125 measurement and transvaginal ultrasound scan [TVS]).

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Large randomized clinical trials (Prostate, Lung, Colorectal and Ovarian Screening Trial; United Kingdom Collaborative Trial of Ovarian Cancer Screening) have been initiated to evaluate whether ovarian cancer screening in the general population by serum CA125 measurement and transvaginal ultrasound scan can reduce mortality. These trials might provide the standards for screening efficacy but will not be completed for several years.1,2 As this evidence is not available, screening for ovarian cancer in the general population is not recommended by any medical organization at this time.3

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Table Graphic Jump Location
Table 43.1Women at moderate risk of developing ovarian cancer
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Similarly, screening for women at only moderately increased risk of developing ovarian cancer (Table 43.1) is usually not justified. For those women, the lifetime risk of ovarian cancer is between 1 in 100 and 1 in 30. This risk is no more than three times the population average. Those women should be advised to visit their general practitioner promptly with any health changes.4

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Women with ovarian cancer risk that is considerably above the average (Table 43.2) might benefit from screening. ...

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