Screening Methods for Detecting Ovarian Cancer Early Ineffective at Reducing Mortality

The results of a randomized control trial emphasized the need for screening methods earlier in disease but did not show a reduction in deaths for patients with ovarian and tubal cancer.

While the use of multimodal screening was effective in detecting ovarian cancer earlier for patients, it failed to lead to a significant reduction in deaths, according to a study published in The Lancet.1

The results for both multimodal screening (MMS) and ultrasound screening (USS) methods from the long-term follow-up to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS; NCT00058032) emphasized the value of screening trials that include cancer mortality as a primary end point of the investigation.

“Our results from the largest ovarian cancer screening trial to date show that on long-term follow-up (median 16.3 years after randomisation), neither MMS or USS, as used in UKCTOCS, significantly reduced deaths from ovarian and tubal cancer,” wrote the investigators.

A total of 202,562 patients were recruited and featured in the primary analysis, with 25% each assigned to the MMS (n = 50,623) and USS groups (n = 50,623), and the remaining 50% assigned to the no screening group (n = 101,314).

At the median follow-up of 16.3 years, 2055 patients were diagnosed with tubal or ovarian cancer, of whom 522 patients (1%) were from the MMS group, 517 (1%) from the USS group, and 1016 (1%) from the no screening group.

In the MMS group, a 47.2% (95% CI, 19.7%-81.1%) increase in stage I disease incidence and a 24.5% (–41.8% to –2.0%) decrease in stage IV disease incidence was observed. More, a 39.2% (95% CI, 16.1%-66.9%) higher incidence of stage I or II disease and a 10.2% (95% CI, –21.3% to 2.4%) lower incidence of stage II or IV disease in the MMS group compared with the no screening group was seen.

Broken down by group, 296 patients (0.6%) in the MMS group, 291 (0.6%) patients in the USS group, and 619 (0.6%) patients in the no screening group died from the disease. Compared with the no screening group, no reduction in ovarian and tubal cancer deaths were seen in either the MMS and USS groups.

“UKCTOCS is the first trial to show that screening can definitely detect ovarian cancer earlier. However, this very large, rigorous trial shows clearly that screening using either of the approaches we tested did not save lives. We therefore cannot recommend ovarian cancer screening for the general population using these methods,” Professor Usha Menon, MBBS, of the MRC Clinical Trials Unit at the University College of London and lead investigator of the study, explained in a press release.2

While these screening methods did not lead to a reduction in death, the research team explained that the data were able to produce insight into designing and implementing a large-scale randomized trial specifically in patients who have no signs of disease. More, it contributes to the advancement of assessing risk, prevention, and diagnosis of ovarian cancer.

Even though the use of general population screening for this disease cannot be recommended, the results further emphasize the need for a screening strategy that can detect ovarian and tubal cancers for patients without symptoms of disease earlier in its course.

“These important findings from a large-scale trial, involving 200,000 participants, show that annual screening did not succeed in reducing deaths from ovarian cancer,” Professor Nick Lemoine, MD, PhD, FRCPath, FMedSci, medical director, NIHR Clinical Research Network, explained in a press release. “However, it’s important to note that negative results can be as important as positive. The study has provided important new evidence and insights into how to conduct and analyse future large-scale randomised clinical trials into ovarian cancer, in the hope that this will prevent and diagnose this disease more effectively in the future.”

References

1. Menon U, Gentry-Maharaj A, Burnell M, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2021;397(10290):2182-2193. doi:10.1016/S0140-6736(21)00731-5

2. Screening for ovarian cancer did not reduce deaths. News release. UCL News. Published Mat 13, 2021. Accessed June 22, 2021. https://bit.ly/3d7zSzK