Consecutive Negative Screening Tests for Ovarian Cancer: A Reliable Basis for Reassurance of Low Ovarian Cancer Mortality Risk?

Authors

Jang J, Bae JK, Kim J, Kim U, Kang S

Affiliations

• Division of Clinical Research, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
• Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
• Division of Clinical Research, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea. sokbom@ncc.re.kr.

Abstract

Although ovarian cancer screening is not recommended for non-high-risk women, they seek screening to alleviate their fear of the disease. Therefore, we investigated whether receiving consecutive negative results is associated with lower risk of ovarian cancer mortality compared to no screening. This study was conducted using data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial, conducted in the United States (n = 52,633). Five-year cumulative ovarian cancer mortality was compared between females with three consecutive negative screening results using transvaginal ultrasound and CA-125 tests (negative group) and those not undergoing screening (control group) via Gray's test. Sensitivity analyses were also conducted considering known factors affecting ovarian cancer risk, such as oral contraceptive use, hormone therapy, parity, and family history of ovarian or breast cancer. The 5-year cumulative ovarian cancer mortality in the negative group was 8.6 deaths/10,000 persons (95% confidence interval [CI], 4.6-12.6 deaths/10,000 persons), which was not different from that in the control group (8.8 deaths/10,000 persons; 95% CI, 5.6-12.1 deaths/10,000 persons; p = 0.79). Furthermore, no evidence of a difference in ovarian cancer mortality was observed between the negative and control groups even among women at low risk, such as those with oral contraceptive use, no menopausal hormone therapy, being parous, and without a family history of breast cancer and ovarian cancer (all p-value ≥ 0.35). It is essential for both physicians and patients to understand that even three consecutive annual negative screenings for ovarian cancer should not be interpreted as evidence of lower ovarian cancer mortality compared with no screening.