Common epithelial tumors account for 90% of ovarian cancers. These tumors derive from the visceral peritoneum of the ovary and from remnants of Mullerian epithelium outside the ovary.

More than 20 000 women are diagnosed with ovarian cancer annually and more than 12 000 die from the disease, making ovarian cancer the most frequent cause of death from gynecologic malignancy.

Risk factors for ovarian cancer include age, a family history of ovarian cancer, and hereditary ovarian cancer syndromes [3.4-3.9]. Pregnancy and use of the oral contraceptive pill are associated with a reduced risk for ovarian cancer [3.10-3.11].

Screening Tests

Potential techniques for screening include pelvic ultrasonography and the serum CA 125 radioimmunoassay. There is limited evidence to support the use of pelvic examination solely to screen for ovarian cancer [5.1].

The ovaries and other pelvic structures may be imaged by either abdominal or transvaginal ultrasonography. Transvaginal ultrasound, using an intravaginal probe, usually provides more detail of ovarian morphologic characteristics.

CA 125 is a tumor marker detectable in the serum of many women with ovarian cancer and in some with endometrial and pancreatic malignancies. Serum CA 125 may also be increased in benign gynecologic conditions, including endometriosis, leiomyomas, pelvic inflammatory disease, and benign ovarian cysts.

Recommendations

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1. For premenopausal and postmenopausal women without a family history of ovarian cancer, screening for ovarian cancer with ultrasound or CA 125 is not recommended.

2. In women with a family history of ovarian cancer in one or more relatives (without evidence of a hereditary cancer syndrome), routine screening with CA 125 or ultrasound in general is not recommended. Women requesting screening should be counseled about their individual risk (considering age, parity, and a history of oral contraceptive pill use), about the potential adverse effects of screening, and about the lack of scientific evidence that deaths from ovarian cancer are decreased by screening. Women and their physicians should consider this information in making individual decisions about screening.

3. For women from a family with the rare hereditary ovarian cancer syndrome, referral for specialist care is recommended.

Rationale

In women at average risk, routine screening using CA 125 or ultrasound is not recommended because of the low incidence of ovarian cancer, the high-false positive rate of available screening methods, and the lack of established benefit from screening [4.2, 6.1-6.3].

Women with a family history of ovarian cancer who are not members of a hereditary cancer syndrome kindred have a threefold increase in risk [3.8-3.9]. The incidence of ovarian cancer increases twofold after age 50, and pregnancy and oral contraceptive pill use are associated with approximately a 50% decrease in risk [3.2, 3.10-3.11]. These factors should be considered in the assessment of an individual woman's risk for ovarian cancer. Women who request screening should be informed of the risk related to testing as well as the lack of scientific evidence showing any benefits from screening [4.1-4.5]. The risk related to testing is the possibility of false-positive results that require further investigation, often including laparotomy. In women older than 50 years who have a family history of ovarian cancer in one first- or second-degree relative (without evidence of a hereditary cancer syndrome), annual screening with CA 125 results in approximately nine false-positive results for every ovarian cancer detected [6.1].

Women from a family with a hereditary ovarian cancer syndrome have a substantial increase in risk for ovarian cancer, with a lifetime risk up to 50% in some patients [3.6, 3.7]. These women should be referred to a gynecologic oncologist for follow-up. Prophylactic oophorectomy is one management strategy in this subgroup. Women who wish to retain their ovaries are appropriate candidates for screening using a combination of CA 125 and ultrasound, preferably in a research setting.