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Clinical Opal #7 - Ovarian cancer screening

Anna Li, a 46 year old high school teacher, presents to you for follow up after a recent metatarsal fracture. At the end of the visit, she asks you whether she can be screened for ovarian cancer.

Anna Li, a 46 year old high school teacher, presents to you for follow up after a recent metatarsal fracture. At the end of the visit, she asks you whether she can be screened for ovarian cancer.

She tells you that one of the other teachers at her school had just been diagnosed and she has become aware that 'there is a blood test that can pick it up early'. She has been very worried about it since her colleague was diagnosed.

Anna is fit and well and has no symptoms on further questioning. She has no family history of breast or ovarian cancer. Her last CST was 2 years ago and normal.

How would you respond to Anna's request?

A clinical practice guideline published in JAMA in 2018 stated that there is clear evidence that screening for ovarian cancer does not reduce ovarian cancer mortality.1 Furthermore, there is evidence that the harms from screening for ovarian cancer can be substantial, including unnecessary surgery for women who have false positive tests. They concluded that the harms of screening for ovarian cancer outweigh the benefit.

This is reflected in the RACGP Guidelines for Preventive Activities in General Practice (Red Book)2 and in the recommendations of Choosing Wisely Australia.3

Anna should therefore be informed that screening for ovarian cancer in asymptomatic, low-risk women like herself is not recommended due to the low sensitivity and specificity of available tests. This requires a sensitive and patient-centred discussion on the benefits and harms of screening.

 

References

  1. US Preventive Services Task Force. Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018.319;6:588-594.
  2. RACGP Preventive Activities in General Practice
  3. Choosing Wisely Australia website

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Dr Simon Morgan

Dr Simon Morgan

Simon is a GP and Medical Educator based in Newcastle, NSW.

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