Purpose: To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA125 estimation) in reducing mortality from ovarian cancer in women at increased genetic risk.
Patients and methods: A cohort of 3532 women at increased risk of ovarian cancer was screened at five European centres between January 1991 and March 2007. Survival from diagnosis of ovarian cancer was calculated using Kaplan-Meier analysis and compared for proven BRCA1/2 carriers with non-carriers and whether the cancer was detected at prevalence or post prevalent scan. Screening was performed by annual transvaginal ultrasound and serum CA125 measurement
Results: 64 epithelial ovarian malignancies (59 invasive and 5 borderline), developed in the cohort. 26 tumours were detected at prevalent round, there were 27 incident detected cancers and 11 interval. Sixty-five percent of cancers were stage 3 or 4, however, stage and survival were little different for prevalent versus post prevalent cancers. Five year and 10-year survival in 49 BRCA1/2 mutation carriers was 58.6% (95% CI 50.9-66.3%) and 36% (95% CI 27-45%), which was significantly worse than for 15 non BRCA-carriers (91.8% (95% CI 84-99.6%) both 5 and 10-year survival p=0.015). However, when borderline tumours were excluded, the difference in survival between carriers and non-carriers was no longer significant.
Conclusion: Annual surveillance, by trans-vaginal ultrasound scanning and serum CA125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumours at a sufficiently early stage to substantially influence survival in BRCA1/2 carriers.