Annual Ovarian Cancer Screenings Do Not Save Lives, Study Suggests; Women Should Listen for Signs of the ‘Cancer that Whispers’

“While we have certainly seen this result in other large randomized trials, the [study] is notable for the remarkable enrollment of more than 200,000 women, but more significantly for its endpoint survival (or lack there of),” Dr. Stephanie Wethington, director of the Gynecologic Oncology Survivorship Program at Johns Hopkins Medicine tells SurvivorNet.

Dr. Wethington believes that the screening tests which attempt to look at the changes in a women’s genes or the molecular makeup of her cells might offer more promise in the future.

For now the best course of action is for women to seek assistance from a medical team if symptoms are present or if something seems off. Ovarian cancer is known as the cancer that whispers because symptoms are vague and can be similar to regular menstrual cycle fluctuations.

In the study, published in The Lancet, researchers categorized participants into one of three groups annual multimodal screening (MMS) where women had a blood test to detect the amount of a specific protein followed by an ultrasound, annual transvaginal ultrasound screening (USS), or no screenings at all. A quarter of the total women were in the MMS group, another quarter were in the USS group and the other half was in the no screening group.

After an average follow-up period of 16.3 years, 2,055 women were diagnosed with tubal or ovarian cancer. Compared with no screening, there were 47 percent more stage I and almost 25 percent less stage IV cases in the group where women had the blood test and ultrasound. But a total of 1,206 women died of the disease, and there was no significant reduction in ovarian and tubal cancer deaths in either of the screening groups compared to the no screening group. Essentially, the women who had the blood test and ultrasound detected ovarian cancer earlier, but just as many deaths occurred no matter the screening process.

Dr. Wethington suggests that we look more into molecular screening tests like CancerSEEK or PAPGene because maybe they could actually help with survival rates.

CancerSeek and PAPGene differ from the blood test used in the study because they look for very different signals of cancer genetic mutations. CancerSeek, for example, is a blood test that looks for a combination of genetic mutations and proteins found in eight different types of cancer. PAPGene, on the other hand, uses fluid from a Pap test to identify DNA sequences that could be cancerous.

More research is needed before any specific ovarian cancer screening methods can be recommended to the general public.

What Does The Research Mean?

The United States has annual screening recommendations already in place for various cancers including colon, breast and cervical cancer but not for ovarian cancer. Researchers from the UK study concluded that, “given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended.”

Mahesh Parmar is the director of the Medical Research Council clinical trials unit at UCL and an author for the study. The results of the study were disappointing for him, but he explained how there was room for hope.

"Either we need to find more individuals at an earlier stage of disease and fewer individuals with late-stage disease through screening, and/or this disease is such that even if you did that, the biology of [ovarian cancer] means that it's going to be aggressive whatever you do, even if you find it at an early stage," Parmar told the Guardian. "Our trial showed that screening was not effective in women who do not have any symptoms of ovarian cancer; in women who do have symptoms, early diagnosis, combined with this better treatment, can still make a difference to quality of life and, potentially, improve outcomes… On top of this, getting a diagnosis quickly, whatever the stage of the cancer, is profoundly important to women and their families."

So, despite findings suggesting that screenings may not save lives, it is important to note that they can still detect tumors at an earlier stage. And if a screening helps detect a tumor sooner, it is possible that an earlier diagnosis could potentially alleviate the severity of treatment for women.

Understanding Ovarian Cancer

Ovarian cancer is when the ovaries, the female reproductive organs, become cancerous. The American Cancer Society estimates that in 2021 about 21,410 women in the United States will receive a new diagnosis of ovarian cancer, and about 13,770 women will die from the disease.

Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, says that ovarian cancer can be difficult to recognize with its subtle symptoms.

RELATED: Ovarian Cancer Symptoms Can Be Hard to Spot

"Ovarian cancer does not have any specific symptoms," Karlan said in an earlier interview with SurvivorNet. "It's often referred to as the cancer that whispers, in that it has symptoms that are really very vague…and nothing that may bring your attention directly to the ovaries."

Ovarian Cancer: The Cancer That Whispers

Dr. Karlan wants women to keep an eye out for a variety of possible symptoms.

"The symptoms include things like feeling full earlier than you usually would when your appetite is strong… Feeling bloated," she added. "Some changes in your bowel habits. Some pain in the pelvis. These are symptoms women may have every month. These are not very specific. But what we've found from multiple studies, it's this constellation of symptoms."

Dr. Wethington also told SurvivorNet that prevention for ovarian cancer is what we should focus on.

“While we work to find a screening test, we must remember that prevention is key and advocate for all women to discuss their family history and individual risk factors with their doctors and ask whether there are risk reducing options available to them,” Dr. Wethington wrote.

Our advice to readers: See your doctor if you feel like something is off. Given that ovarian cancer can have no symptoms or a myriad of symptoms that you might easily brush off as nothing, it’s important to always seek medical attention when your gut is telling you something might be wrong. That doesn’t mean we should assume the worst every time we feel bloated or have a change in appetite, but it does mean that we should always try to listen to the signs our body is giving us.

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