Ovarian cancer has a poor prognosis, with just 40% of patients surviving 5 years. For this study, the authors designed a trial to establish the effect of early detection by screening on ovarian cancer mortality: the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). The primary aim was to assess the effect of screening on disease mortality. This report is a key landmark for the programme, providing the first ovarian cancer mortality data from UKCTOCS.
During the 1990s, findings from large prospective studies of screening showed that both CA125 and ultrasound-based ovarian cancer screening could identify preclinical cases of ovarian cancer. In the year before the start of this trial, a systematic review of 25 ovarian cancer screening studies commissioned by the National Health Service Health Technology Assessment Programme reported that although ultrasound and multimodal screening can detect ovarian cancer in asymptomatic women, the effect of screening on ovarian cancer was unproven. The authors concluded that screening should not be introduced into clinical practice until further information was available from randomised trials designed to assess the effect of ovarian cancer screening on mortality and its adverse effects and cost-effectiveness.
This trial is the first randomised controlled trial of ovarian cancer screening to produce findings that show that in postmenopausal women from the general population, annual screening with use of the multimodal strategy is safe and could reduce deaths due to ovarian cancer. These findings are derived from one of the largest randomised trials ever done and renew hope that death rates from the most lethal of all gynaecological malignancies can be reduced through early detection.
The findings suggest that a multimodal approach to screening might detect ovarian cancer sufficiently early to reduce mortality. To establish the magnitude of this reduction in deaths, a longer duration of follow-up is needed. Meanwhile, efforts to refine ovarian cancer screening strategies should continue.