Ovarian Cancer

Basic Overview

Among women in the United States, ovarian cancer is the eighth most common cancer and the fifth leading cause of cancer death, after lung and bronchus, breast, colorectal, and pancreatic cancers.* 1

Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Mortality and incidence rates are higher for white women than for any other racial or ethnic group. In the United States, approximately $2.2 billion (in 2004 dollars) is spent each year on the treatment of ovarian cancer. 2

*Incidence counts cover approximately 98% of the U.S. population. Death counts cover 100% of the U.S. population. Use caution in comparing incidence and death counts.

Risk Factors

Although most cases of ovarian cancer occur in women aged 50 years or older, the disease can occur in younger women. 5 The most common form of ovarian cancer—epithelial—usually is diagnosed in women aged 40 years or older. 5 Risk for all forms of the disease begins to increase as a woman gets older. 4

A woman's chance of having ovarian cancer increases if one or more of her close relatives (i.e., mother, daughter, or sister) has had the disease. In some cases, women may inherit genes that substantially increase the risk of developing ovarian cancer. 4 Women with a history of breast, endometrial, or colon cancer also have a greater chance of developing ovarian cancer than do women who have not had these cancers.

Reducing Risk

Researchers have identified several factors that may decrease a woman's risk of developing ovarian cancer, including childbearing and the use of oral contraceptives. 4 Although reproductive, demographic, and lifestyle factors affect risk of developing ovarian cancer, the single greatest risk factor for ovarian cancer is having a family history of the disease. 4

Screening

CDC and other federal agencies follow the ovarian cancer screening recommendations set forth by the U.S. Preventive Services Task Force (USPSTF), which is supported by the Agency for Healthcare Research and Quality (AHRQ). USPSTF recommends against routine screening for ovarian cancer. There is no evidence that any screening test—CA-125, ultrasound, or pelvic examination—reduces deaths from ovarian cancer. 3

The USPSTF, first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the AHRQ, is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.

The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

Summary of Recommendation
The USPSTF recommends against routine screening for ovarian cancer.

Rationale: The USPSTF found fair evidence that screening with serum CA-125 level or transvaginal ultrasound can detect ovarian cancer at an earlier stage than it can be detected in the absence of screening; however, the USPSTF found fair evidence that earlier detection would likely have a small effect, at best, on mortality from ovarian cancer. Because of the low prevalence of ovarian cancer and the invasive nature of diagnostic testing after a positive screening test, there is fair evidence that screening could likely lead to important harms. The USPSTF concluded that the potential harms outweigh the potential benefits.


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References

1. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007.

2. Brown ML, Riley GF, Schussler N, Etzioni RD. Estimated health care costs related to cancer treatment from SEER-Medicare data. Medical Care 2002;40(8 Supplement)IV:104–117.

3. U.S. Preventive Services Task Force. Screening for Ovarian Cancer. Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research and Quality 2004.

4. National Institutes of Health. PDQ Ovarian Cancer Prevention.

5. Weiss NL, Cook LS, Farrow DC, Rosenblatt KA. Ovarian cancer. In: Shottenfeld D and Fraumeni JF, eds. Cancer Prevention and Epidemiology and Prevention. 2nd ed. New York: Oxford University Press; 1996.

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Content source: Division of Cancer Prevention and Control





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