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Ovarian cancer: challenges of early detection

Nature Clinical Practice Oncology volume 4, pages 498–499 (2007)Cite this article

Ovarian cancer (OC) is a disease with a high case-fatality ratio. Although 5-year survival rates have improved, mortality has remained high. Most deaths occur in women with invasive epithelial OC (EOC), which is typically associated with nonspecific symptoms and advanced stage at diagnosis. Concerted efforts are underway to develop early detection strategies. Preliminary evidence indicates that such strategies provide a survival benefit. In a randomized controlled trial of OC screening, median survival time in women developing OC was significantly increased in the screened group (72.9 months) compared with the control group (41.8 months).1 Single-arm trials have also reported improved survival with OC screening,2 although a 'healthy-volunteer effect' and detection of borderline and granulosa cell tumors would have amplified the effect. None of these trials have been large enough to evaluate the impact of screening on OC mortality.

Knowledge of the natural history of OC is limited. The current view is that an unknown proportion of tumors arises de novo from the ovarian surface epithelium or inclusion cysts.3 Borderline and benign neoplasms are likely to represent only the minority of invasive EOCs. Postmenopausal women with benign complex ovarian cysts do not share the same risk-factor profile as those with OC,4 and removal of persistent ovarian cysts does not result in a decrease in OC deaths.5 Consequently, the goal of OC screening is limited to detection of asymptomatic, low-volume invasive disease.

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Acknowledgements

This work was undertaken at UCLH/UCL UK, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centre's funding scheme.

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  1. Gynaecological Cancer Research Centre, UCL Elizabeth Garrett Institute of Women's Health, Maple House, 149 Tottenham Court Road, London W1T 7DN, UK u.menon@ucl.ac.uk

Authors and Affiliations

  1. U Menon is a Senior Lecturer and Consultant Gynaecologist, and Head of the Gynaecological Cancer Research Centre at the Institute for Women's Health, University College London, London, UK.,

    Usha Menon

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Competing interests

U Menon is one of the investigators on two large grants addressing the issue of ovarian cancer screening: UKTOCS, funded by the Medical Research Council, Cancer Research UK and the Department of Health; and UKFOCSS, funded by the charities Cancer Research UK and Eve Appeal plus the Department of Health.

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Menon, U. Ovarian cancer: challenges of early detection. Nat Rev Clin Oncol 4, 498–499 (2007). https://doi.org/10.1038/ncponc0906

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