By Katherine Hobson

The government estimates that more than 15,000 women died last year from ovarian cancer.

But routine screening of women with no symptoms isn’t recommended by the United States Preventive Services Task Force, American Congress of Obstetricians and Gynecologists or other professional groups, even for women at high risk for the disease. That’s because the benefits of the available tests — a transvaginal ultrasound and a blood test that detects an antigen called CA-125 — haven’t been shown to outweigh their risks (such as complications from unnecessary surgery), or to reduce the number of deaths.

Despite that evidence, a new study finds that when presented with a scenario of a woman coming to her annual check-up, a significant percentage of physicians surveyed would screen for ovarian cancer.

Some 28.5% of the 1,088 primary-care docs? — OB/GYNs, family physicians and general internists — surveyed said they “sometimes” or “almost always” offered or ordered ovarian-cancer screening tests for low-risk women. when the vignette involved a woman at medium risk of the disease, that proportion jumped to 65.4% of physicians.

About a third of physicians reported believing that ultrasound or CA-125 blood testing is an effective screening test for ovarian cancer, the study found. It’s unclear why that is, and more research is needed to discover why, says Laura-Mae Baldwin, an author of the study and professor of family medicine at the University of Washington.

“We know that in medicine we have an enthusiasm for screening,” she says. “We want to find diseases before they can cause harm.”

The study also found that physicians were more likely to say they’d order screening for patients who requested it — even if the doctor herself didn’t believe screening was effective.

In that scenario, physicians may be trying to maintain a relationship with the patient, or they “may lack confidence in explaining why the test is more harmful than beneficial,” says Baldwin. she says there’s an important role for clinical tools that could accurately illustrate the level of risk faced by a particular woman and also illustrate the harms and benefits of the test.

The study is published in the Annals of Internal Medicine.

There are limitations to the research: doctors were reporting how they’d react to the scenarios presented to them, not discussing actual patients. and while there was a 62% response rate to the initial questionnaire sent to physicians, the results may not generalize to the doctors who didn’t respond, the authors write.

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Dr Vichien Srimuninnimit of Siriraj Hospital’s Medical Oncology Division said the goal of cancer screening was to find pre-cancerous lesions and cancer before symptoms appear, which can help patients access treatment, but some screening tests such as colonoscopy can cause serious problems.

As well, some tests can show false-positive results, which cause patient anxiety and unnecessary invasive diagnostic procedures, which also entail risks and cost. Conversely, a false-negative result can lead to a delay in seeking medical care even if there are genuine symptoms.

“Finding cancer may not improve the person’s health or help the person live longer,” Vichien said.

He was speaking at the second annual “Cancer Prevention, Early Detection and Interception” conference organised by Chulabhorn Hospital, participated in by 360 cancer researchers nationwide.

“Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. also, treatments for cancer have side effects,” he pointed out.

Screening tests for breast, cervical, colon, prostate, lung and ovarian cancer are mostly available at private hospitals.

Citing the American Cancer Society (ACS) guideline for breast-cancer screening, Vichien said yearly mammograms should start at age 40 and continue for as long as a woman is in good health.

Clinical breast exams should be undertaken about every three years by women in their 20s and 30s and every year for woman 40 and over. Meanwhile, breast self-examination is an option for women starting in their 20s.

But the US Preventive Services Task Force has recommended that mammography screening should be conducted every two years to reduce risk of breast cancer by nearly half. Moreover, the USPSTF has suggested that doctors not teach women to perform breast self-examination, as it has been found to have no mortality benefit.

The ACS also recommended that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their healthcare provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risk and potential benefits associated with screening for that disease.

Despite the high cost and limited benefit of screening, it should be done for men with family history of prostate cancer.

However, Vichien said screening should be done for diseases that are important health problems and for which there is a detectable pre-clinical phase.

A cancer-screening method should be accepted as standard care only when its value has been demonstrated in randomised controlled trials, he said.

Low-dose computed tomography scans might help reduce lung cancer mortalities among heavy smokers and former smokers, according to a new report. but further analysis of the findings is needed before screening recommendations can be issued for the disease, said a statistician for the study.

There is no generally accepted screening test for lung cancer. the U.S. Preventive Services Task Force said evidence is insufficient to recommend for or against screening asymptomatic people for the disease with either low-dose CT scans, chest x-rays, sputum cytology or a combination of these tests.

Results of the study, which were published online Nov. 2 in Radiology, found that CT scans decreased the mortality rate of heavy smokers and former smokers by 20.3% compared with chest x-rays. the National Cancer Institute sponsored the study.

“For the first time, we have definite proof that screening for lung cancer can reduce mortality,” said Constantine A. Gatsonis, PhD, a lead statistician for the study and a professor of biostatistics at Brown University.

He encourages physicians to consider the new data when they are deciding what test to recommend for screening a patient’s lungs.

Lung cancer is the leading cause of cancer-related death among men and women in the U.S., according to the Centers for Disease Control and Prevention. the NCI estimates that 222,520 new cases of lung cancer will be diagnosed this year, and 157,300 people will die of the disease.

Researchers examined data on 53,456 current and former heavy smokers age 55 to 74 who were enrolled in the National Lung Screening Trial between August 2002 and April 2004. Participants smoked at least one pack a day for 30 years and had no signs, symptoms or history of lung cancer.

About half of the individuals were randomly assigned to receive three annual low-dose CT scans, and the other half got three standard x-rays. Participants were screened when they enrolled in the study and at the end of their first and second years in the trial. Then they were followed for as many as seven years. Radiologists reviewed the images for lung nodules and masses. Participants whose tests revealed an abnormality received follow-up recommendations.

At the end of the study in October, 796 of the participants had died of lung cancer. In the group that received CT scans, 44.5% died of the disease. the figure was 55.5% among those who got x-rays (ncbi.nlm.nih.gov/pubmed/21045183/).

The potential disadvantages of CT procedures include the cumulative effects of radiation from multiple scans and false positives that can lead to unnecessary lung biopsies.

“At the end of the day, we have to balance the risks of [lung cancer] screening with the benefits. That will be part of a more detailed analysis” of the study’s findings, which will be published in the near future, Gatsonis said.

This content was published online only.

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