Gynecology Specialists Note
On Sept. 11, 2012 the Virginian-Pilot featured an article titled “Ovarian cancer tests ill-advised for some, panel says”. We’ve posted it below in case you missed it.
All of the GYN doctors at Gynecology Specialists agree with these findings.
If you have questions about this issue, please call us at (757) 312-8221.
Ovarian cancer tests ill-advised for some, panel says
By Denise Grady, The New York Times – 9/11/2012
Tests commonly recommended to screen healthy women for ovarian cancer do more harm than good and should not be performed, a panel of medical experts said Monday.
The screenings – blood tests for a substance linked to cancer, and ultrasound scans to examine the ovaries – do not lower the death rate from the disease and yield many false-positive results that lead to unnecessary operations with high complication rates, the panel said.
“There is no existing method of screening for ovarian cancer that is effective in reducing deaths,” Dr. Virginia Moyer, chairwoman of the expert panel, said in a statement from the group, the U.S. Preventive Services Task Force. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery.”
The advice against testing applies only to healthy women with an average risk of ovarian cancer, not to those with suspicious symptoms and not to women at high risk because they carry certain genetic mutations or have a family history of the disease.
The recommendations are just the latest in a series of challenges to cancer screening issued by the group, which has also rejected PSA screening for prostate cancer in men and routine mammograms in women younger than 50. The task force is a group of 16 experts, appointed by the government but independent, that makes recommendations about screening tests and other efforts to prevent disease. Its advice is based on medical evidence, not cost.
The recommendations against screening for ovarian cancer were published Monday in Annals of Internal Medicine. The warning is not new – the panel is reaffirming its own earlier advice. And though the task force has sometimes drawn fire in the past, particularly with its stand on mammograms, it has plenty of support in this case. Other medical groups, including the American Cancer Society and the American Congress of Obstetricians and Gynecologists, have for years been discouraging tests to screen for ovarian cancer.
But some doctors continue to recommend screening anyway, and patients request it, clinging to the mistaken belief that the tests can somehow find the disease early enough to save lives. A report published in February in Annals of Internal Medicine, based on a survey of 1,088 doctors, said about a third of them believed the screening was effective and that many routinely offered it to patients.
“We are fueled by hope,” Moyer said.
For its latest recommendations, the panel relied heavily on a large study published last year in The Journal of the American Medical Association of 78,216 women ages 55 to 74. Half got screening, and half did not, and they were followed for 11 to 13 years. The screening consisted of ultrasound exams and blood tests for elevated levels of a substance called CA-125, which can be a sign of ovarian cancer.
There was no advantage to screening: The death rate from ovarian cancer was the same in the two groups. But among the women who were screened, nearly 10 percent – 3,285 women – had false-positive results. Of those women with false positives, 1,080 had surgery, usually to remove one or both ovaries. Only after the operations were done was it clear that they had been unnecessary. And at least 15 percent of the women who had surgery had at least one serious complication, such as blood clots, infections or surgical injuries to other organs.
To find one case of ovarian cancer, 20 women had to undergo surgery.
The problem with the tests is that CA-125 can be elevated by conditions other than cancer, and ultrasound can reveal ovarian enlargement or cysts that are benign but that cannot be distinguished from cancer without surgery to take out the ovary.
Dr. Barbara A. Goff, a gynecologic oncologist at the Fred Hutchinson Cancer Research Center in Seattle, and an author of the study last year that found doctors still in favor of screening, said: “If patients request it, then I think a lot of times physicians feel it’s just easier to order the test, particularly if it’s covered by insurance, rather than taking the time to explain why it may not be good, that it could lead to inappropriate surgery, could lead to harm. I don’t think they think through the consequences.”
It is often easier, she said, to talk patients into surgery than to talk them out of an operation or test they have set their minds on.
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If you have questions about ovarian cancer, mammograms, or other GYN issues, and live in Virginia Beach, Chesapeake, Norfolk, Portsmouth, Eastern Shore, Peninsula, Hampton Roads or North Carolina, please contact our GYN clinic at (757) 312-8221. Our GYN doctors are here to help you.
About our GYN Clinic
Our three female gynecologists and Nurse Practitioner provide comprehensive gynecology services to women and girls of all ages in Virginia Beach, Chesapeake, Norfolk, Portsmouth, Eastern Shore, Peninsula, Hampton Roads and North Carolina. Our gynecology care includes ovarian cancer, mammograms, and more.