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Ovarian cancer screening by GPs justified, research finds

By Lilian Anekwe

Ovarian cancer screening would be feasible in primary care, according to 'encouraging' early results of a major Department of Health funded analysis.

Researchers found ovarian cancer was prevalent enough in the women screened to justify a screening programme, and high levels of sensitivity and specificity from screening. But the researchers were cautious in their interpretation of the results, and stressed that while the prevalence detected by the trial was high enough to suggest screening would be worthwhile, it was too early to judge whether screening for ovarian cancer would reduce deaths from the disease.

More than 200,000 women 50 and 74 recruited from 27 PCTs were randomly assigned to no treatment, annual genetic screening for CA125 followed by transvaginal ultrasound screening in women at high risk, or annual screening with transvaginal ultrasound.

Screening detected most women who developed ovarian cancer. 90% (34 of 38) were detected using the combined genetic and ultrasound strategy, and 75% (24 of 32) were detected using the ultrasound only strategy.

Overall, 87 cancer cases were detected, with a similar number detected in the multimodal and single-mode strategies (42 and 45, respectively).

Speci?city was higher in the group screened using combined genetic analysis and ultrasound than in the ultrasound only group, resulting in lower rates of repeat testing and surgery.

The high levels of sensitivity, specificity and positive predictive values (see box) led the researchers, whose study is published online first in the April issue of Lancet Oncology, to conclude primary-care based screening strategies are ‘feasible'.

Lead researcher Professor Ian Jacobs, director of the University College London Institute for Women's Health, said: ‘There is a long way to go before we have firm evidence as to whether or not screening is able to detect cancer early enough to save lives.

‘It will also be essential to balance any benefits offered by screening with the downside, as it is recognised that screening can cause anxiety and lead to some unnecessary operations.'

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