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Should we be screening for ovarian cancer?

Authors
Publisher
Sri Lanka college of Obstetricians & Gynaecologists
Publication Date
Keywords
  • Obstetrics & Gynaecology
  • Screening
  • Ovarian Cancer
Disciplines
  • Biology
  • Chemistry
  • Ecology
  • Medicine

Abstract

68 Sri Lanka Journal of Obstetrics and Gynaecology Kanishka Karunaratne Should we be screening for ovarian cancer? Kanishka Karunaratne1 Sri Lanka Journal of Obstetrics and Gynaecology 2011; 33: 68-69 1 Consultant Gynae-oncologist, National Cancer Institute, Maharagama, Sri Lanka. E-mail: [email protected] Point of View Ovarian cancer carries the worst prognosis of all gynaecological cancers, with an overall five-year survival rate of around 30-40 percent. For women diagnosed with early-stage disease the five-year survival rate is over 80 percent1. Majority of the ovarian cancers present in advanced stages due to vague symptoms. Advanced stage disease carries a poor five- year survival rate of around 15 percent. Ovarian cancer accounts for 4 percent of all cancers in women. In Sri Lanka the incidence is around 12 per 100000 and had shown an upward trend during the last two decades. Value of early diagnosis Most improvements in survival have been in women presenting with stage I and stage II disease. This suggests that early detection of ovarian cancer could greatly improve the prognosis. However, due to lack of specific symptomatology, early diagnosis is often difficult. Dispelling the myth that ovarian cancer is a 'silent killer' studies have shown that the symptoms are present in more than 90 percent of women with early disease and may be present up to 15 months before diagnosis2,3. These symptoms include persistent pelvic and abdominal pain, abdominal distention and bloating. However, the natural history of ovarian cancer is not well understood and there is, at present, no evidence that ovarian cancer screening can reduce the mortality. Potential screening tests There is no single effective screening test for ovarian cancers. The main strategy for screening includes both biochemical markers and transvaginal or pelvic ultrasound. Transvaginal ultrasound has a high sensi- tivity but a low specificity for malignant lesions4. This results in many women requiring further

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