From the 1University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; 2Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; 3Marshfield Medical Research and Education Foundation, Marshfield, Wisconsin; 4Information Management Services, Rockville, Maryland; 5University of Minnesota, Minneapolis, Minnesota; 6Pacific Health Research Institute, Honolulu, Hawaii; 7Henry Ford Health System, Detroit, Michigan; 8University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; 9Lombardi Cancer Center, Georgetown University, Washington, DC; 10Washington University School of Medicine, St. Louis, Missouri; 11University of Colorado Cancer Center, University of Colorado Denver, Denver, Colorado; 12Westat, Inc., Rockville, Maryland; and 13Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah.
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OBJECTIVE:To test whether annual screening with transvaginal ultrasonography and CA 125 reduces ovarian cancer mortality.METHODS:Data from the first four annual screens, denoted T0–T3, are reported. A CA 125 value at or above 35 units/mL or an abnormality on transvaginal ultrasonography was considered a positive screen. Diagnostic follow-up of positive screens was performed at the discretion of participants’ physicians. Diagnostic procedures and cancers were tracked and verified through medical records.RESULTS:Among 34,261 screening arm women without prior oophorectomy, compliance with screening ranged from 83.1% (T0) to 77.6% (T3). Screen positivity rates declined slightly with transvaginal ultrasonography, from 4.6 at T0 to 2.9–3.4 at T1–T3; CA 125 positivity rates (range 1.4–1.8%) showed no time trend. Eighty-nine invasive ovarian or peritoneal cancers were diagnosed; 60 were screen detected. The positive predictive value (PPV) and cancer yield per 10,000 women screened on the combination of tests were similar across screening rounds (range 1.0–1.3% for PPV and 4.7–6.2 for yield); however, the biopsy (surgery) rate among screen positives decreased from 34% at T0 to 15–20% at T1–T3. The overall ratio of surgeries to screen-detected cancers was 19.5:1. Seventy-two percent of screen-detected cases were late stage (III/IV).CONCLUSION:Through four screening rounds, the ratio of surgeries to screen-detected cancers was high, and most cases were late stage. However, the effect of screening on mortality is as yet unknown.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, www.clinicaltrials.gov, NCT00002540LEVEL OF EVIDENCE:II