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Mega Ovarian Cancer Screening Trial Shows Modest Reduction in Mortality

Mega Ovarian Cancer Screening Trial Shows Modest Reduction in Mortality One of the largest ever randomized trials has concluded that ovarian cancer screening may reduce ovarian cancer mortality by an estimated 20% after up to 14 years (Jacobs IJ et al. Lancet. doi:10.1016/S0140-6736(15)01224-6 [published online December 17, 2015]). Ovarian cancer has had a poor prognosis for 3 decades; currently, less than 30% of patients are diagnosed at an early, potentially curable, stage. A recent trial investigates the benefits of ovarian cancer screening. Steve Gschmeissner/sciencesource.com The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) randomly assigned 202 638 postmenopausal women in a 1:1:2 ratio to annual multimodal screening (MMS) with serum CA125 interpreted with the risk of ovarian cancer algorithm, rather than an absolute cutoff, and with transvaginal ultrasound scan (TVS) as a second-line test (MMS group); annual TVS alone (USS group); or no screening. The MMS and USS groups were offered 7 to 11 screens and followed up for 14 years from randomization. At a median follow-up of 11.1 years, ovarian cancers were diagnosed in 0.7% of women in the MSS group and 0.6% of women in the USS and no-screening groups. Only 59% of ovarian cancers were detected by multimodal screening and 51% by ultrasound alone. According to the primary outcome of ovarian cancer death by the end of the trial, there were no significant reductions in mortality in the MSS and USS groups (15% and 11%, respectively) relative to no screening. The relative mortality reduction was 8% after 7 years of annual screening but increased to 23% in the 8- to 14-year period after screening in the MSS group, comparable with that for the USS group (2% in years 0 to 7 and 21% in years 8 to 14). An analysis excluding women who had undiagnosed ovarian cancer when they joined the trial showed a significant mortality reduction of 28% in years 8 to 14 after screening with MMS, providing encouraging evidence for the utility of this screening approach. The difference in mortality between women who were screened vs those who were not seems likely to increase over time, according to the authors, who suggest additional follow-up of the UKCTOCS cohort “before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening.” http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Mega Ovarian Cancer Screening Trial Shows Modest Reduction in Mortality

JAMA , Volume 315 (8) – Feb 23, 2016

Mega Ovarian Cancer Screening Trial Shows Modest Reduction in Mortality

Abstract

One of the largest ever randomized trials has concluded that ovarian cancer screening may reduce ovarian cancer mortality by an estimated 20% after up to 14 years (Jacobs IJ et al. Lancet. doi:10.1016/S0140-6736(15)01224-6 [published online December 17, 2015]). Ovarian cancer has had a poor prognosis for 3 decades; currently, less than 30% of patients are diagnosed at an early, potentially curable, stage. A recent trial investigates the benefits of ovarian cancer screening. Steve...
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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2016.0481
Publisher site
See Article on Publisher Site

Abstract

One of the largest ever randomized trials has concluded that ovarian cancer screening may reduce ovarian cancer mortality by an estimated 20% after up to 14 years (Jacobs IJ et al. Lancet. doi:10.1016/S0140-6736(15)01224-6 [published online December 17, 2015]). Ovarian cancer has had a poor prognosis for 3 decades; currently, less than 30% of patients are diagnosed at an early, potentially curable, stage. A recent trial investigates the benefits of ovarian cancer screening. Steve Gschmeissner/sciencesource.com The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) randomly assigned 202 638 postmenopausal women in a 1:1:2 ratio to annual multimodal screening (MMS) with serum CA125 interpreted with the risk of ovarian cancer algorithm, rather than an absolute cutoff, and with transvaginal ultrasound scan (TVS) as a second-line test (MMS group); annual TVS alone (USS group); or no screening. The MMS and USS groups were offered 7 to 11 screens and followed up for 14 years from randomization. At a median follow-up of 11.1 years, ovarian cancers were diagnosed in 0.7% of women in the MSS group and 0.6% of women in the USS and no-screening groups. Only 59% of ovarian cancers were detected by multimodal screening and 51% by ultrasound alone. According to the primary outcome of ovarian cancer death by the end of the trial, there were no significant reductions in mortality in the MSS and USS groups (15% and 11%, respectively) relative to no screening. The relative mortality reduction was 8% after 7 years of annual screening but increased to 23% in the 8- to 14-year period after screening in the MSS group, comparable with that for the USS group (2% in years 0 to 7 and 21% in years 8 to 14). An analysis excluding women who had undiagnosed ovarian cancer when they joined the trial showed a significant mortality reduction of 28% in years 8 to 14 after screening with MMS, providing encouraging evidence for the utility of this screening approach. The difference in mortality between women who were screened vs those who were not seems likely to increase over time, according to the authors, who suggest additional follow-up of the UKCTOCS cohort “before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening.”

Journal

JAMAAmerican Medical Association

Published: Feb 23, 2016

There are no references for this article.