Screening for Ovarian Cancer

  • Angelito Magno


Gynecologic cancer is a major disease burden worldwide. Based on the 2012 GLOBOCAN Worldwide estimates of cancer incidences and mortality from the International Agency for Research on Cancer (IARC), cervical, endometrial, and ovarian cancers rank fourth, sixth, and seventh highest new cases, respectively, with cervical cancer and ovarian cancer as fourth and eighth leading cause of cancer deaths. From the 2014 Surveillance, Epidemiology, and End Results (SEER) Program data and the Centers for Disease Control and Prevention’s (CDC’s) National Program of Cancer Registries (NPCR) data in the United States, cancer of the uterine corpus was the fourth most common new cancer cases, with 52,630 new cases, and ovarian cancer was the fifth most common cause of death, with 14,270 deaths. The lifetime risk of a woman to develop ovarian cancer is 1 in 75 and the risk of death from the disease is 1 in 100. This chapter will discuss screening for ovarian cancer, which will be divided into screening among healthy individuals (general population and high-risk population) and individuals (asymptomatic or symptomatic) who have ovarian masses requiring differentiation of benign from malignant tumor.


Ovarian cancer Ovarian cancer screening Tumor markers Transvaginal ultrasound Multimodal markers RMI ROMA IOTA 


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefGoogle Scholar
  2. 2.
    Jiang X, Tang H. Epidemiology of gynecologic cancers in China. J Gynecol Oncol. 2018;29(1):e7.CrossRefGoogle Scholar
  3. 3.
    Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med. 2017;14(1):9–32.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Pal T, Permuth-Wey J, Betts JA, Krischer JP, Fiorica J, Arango H, et al. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer. 2005;104(12):2807–16.PubMedCrossRefGoogle Scholar
  5. 5.
    Viswanathan A, Kim DH, Reid N, Kline DG. Surgical management of the pelvic plexus and lower abdominal nerves. Neurosurgery. 2009;65(4 Suppl):A44–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Huncharek M, Kupelnick B. Dietary fat intake and risk of epithelial ovarian cancer: a meta-analysis of 6,689 subjects from 8 observational studies. Nutr Cancer. 2001;40(2):87–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Crew KD, Neugut AI. Aspirin and NSAIDs: effects in breast and ovarian cancers. Curr Opin Obstet Gynecol. 2006;18(1):71–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Kjaer SK, Mellemkjaer L, Brinton LA, Johansen C, Gridley G, Olsen JH. Tubal sterilization and risk of ovarian, endometrial and cervical cancer. A Danish population-based follow-up study of more than 65 000 sterilized women. Int J Epidemiol. 2004;33(3):596–602.PubMedCrossRefGoogle Scholar
  9. 9.
    Koshiyama M, Matsumura N. Recent concepts of ovarian carcinogenesis: type I and type II. Biomed Res Int. 2014;2014:934261.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Buys SS, Partridge E, Greene MH, Prorok PC, Reding D, Riley TL, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol. 2005;193(5):1630–9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–303.PubMedCrossRefGoogle Scholar
  12. 12.
    Pinsky PF, Prorok PC, Yu K, Kramer BS, Black A, Gohagan JK, et al. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer. 2017;123(4):592–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Moyer VA. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012;157(12):900–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2016;387(10022):945–56.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Mills K, Fuh K. Recent advances in understanding, diagnosing, and treating ovarian cancer. F1000Res. 2017;6:84.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Daly M, Allen J, Axilbund J, Buys S, Crawford B, Farrell C, et al. NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment: breast and ovarian (version 1/2011). Fort Washington: National Comprehensive Cancer Network; 2011.Google Scholar
  17. 17.
    Skates SJ, Greene MH, Buys SS, Mai PL, Brown P, Piedmonte M, et al. Early detection of ovarian cancer using the risk of ovarian cancer algorithm with frequent CA125 testing in women at increased familial risk - combined results from two screening trials. Clin Cancer Res. 2017;23(14):3628–37.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst. 2009;101(2):80–7.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Kauff ND, Domchek SM, Friebel TM, Robson ME, Lee J, Garber JE, et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol. 2008;26(8):1331–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Mourits MJ, de Bock GH. European/U.S. comparison and contrasts in ovarian cancer screening and prevention in a high-risk population. Am Soc Clin Oncol Educ Book. 2017;37:124–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Ebell MH, Culp MB, Radke TJ. A systematic review of symptoms for the diagnosis of ovarian cancer. Am J Prev Med. 2016;50(3):384–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Ebell MH, Culp M, Lastinger K, Dasigi T. A systematic review of the bimanual examination as a test for ovarian cancer. Am J Prev Med. 2015;48(3):350–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Manegold-Brauer G, Bellin AK, Tercanli S, Lapaire O, Heinzelmann-Schwarz V. The special role of ultrasound for screening, staging and surveillance of malignant ovarian tumors: distinction from other methods of diagnostic imaging. Arch Gynecol Obstet. 2014;289(3):491–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaloo PL, Khazali S, Hoy D, Sadoon S. Management of suspected ovarian masses in premenopausal women. 2011.Google Scholar
  25. 25.
    American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016;128(5):e210–e26.CrossRefGoogle Scholar
  26. 26.
    Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol. 2005;23(34):8794–801.PubMedCrossRefGoogle Scholar
  27. 27.
    Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016;214(4):424–37.PubMedCrossRefGoogle Scholar
  28. 28.
    Perkins GL, Slater ED, Sanders GK, Prichard JG. Serum tumor markers. Am Fam Physician. 2003;68(6):1075–82.PubMedGoogle Scholar
  29. 29.
    Escudero JM, Auge JM, Filella X, Torne A, Pahisa J, Molina R. Comparison of serum human epididymis protein 4 with cancer antigen 125 as a tumor marker in patients with malignant and nonmalignant diseases. Clin Chem. 2011;57(11):1534–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Park Y, Lee JH, Hong DJ, Lee EY, Kim HS. Diagnostic performances of HE4 and CA125 for the detection of ovarian cancer from patients with various gynecologic and non-gynecologic diseases. Clin Biochem. 2011;44(10–11):884–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Sandri MT, Bottari F, Franchi D, Boveri S, Candiani M, Ronzoni S, et al. Comparison of HE4, CA125 and ROMA algorithm in women with a pelvic mass: correlation with pathological outcome. Gynecol Oncol. 2013;128(2):233–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Anton C, Carvalho FM, Oliveira EI, Maciel GA, Baracat EC, Carvalho JP. A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses. Clinics (Sao Paulo). 2012;67(5):437–41.CrossRefGoogle Scholar
  33. 33.
    Bristow RE, Hodeib M, Smith A, Chan DW, Zhang Z, Fung ET, et al. Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass. Am J Obstet Gynecol. 2013;209(6):581.e1–8.CrossRefGoogle Scholar
  34. 34.
    Zhang P, Wang C, Cheng L, Zhang P, Guo L, Liu W, et al. Development of a multi-marker model combining HE4, CA125, progesterone, and estradiol for distinguishing benign from malignant pelvic masses in postmenopausal women. Tumour Biol. 2016;37(2):2183–91.PubMedCrossRefGoogle Scholar
  35. 35.
    Ueland FR. A perspective on ovarian cancer biomarkers: past, present and yet-to-come. Diagnostics (Basel). 2017;7(1):E14.CrossRefGoogle Scholar
  36. 36.
    Coleman RL, Herzog TJ, Chan DW, Munroe DG, Pappas TC, Smith A, et al. Validation of a second-generation multivariate index assay for malignancy risk of adnexal masses. Am J Obstet Gynecol. 2016;215(1):82.e1–e11.CrossRefGoogle Scholar
  37. 37.
    Bristow RE, Smith A, Zhang Z, Chan DW, Crutcher G, Fung ET, et al. Ovarian malignancy risk stratification of the adnexal mass using a multivariate index assay. Gynecol Oncol. 2013;128(2):252–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016;3:Cd010360.PubMedGoogle Scholar
  39. 39.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Angelito Magno
    • 1
  1. 1.Department of Obstetrics and Gynecology, Section of Gynecologic OncologyDe La Salle Health Sciences Institute, De La Salle University Medical CenterDasmarnas CityPhilippines

Personalised recommendations