Screening annually for ovarian cancer failed to reduce the number of deaths from the disease, UK study results show today.
The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), led by UCL, analysed data from more than 200,000 women aged 50-74 between 2001 and 2005, who were followed up for an average of 16 years.
They were randomly allocated to one of three groups: no screening; annual screening using an ultrasound scan; and annual multimodal screening involving a blood test followed by an ultrasound scan as a second line test.
Writing in the latest edition of The Lancet, the researchers found using multimodal testing succeeded in picking up cancers at an early stage, but neither screening method led to fewer deaths.
Professor Usha Menon, of the MRC Clinical Trials Unit at UCL and UKTOCS lead investigator, said: “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.
“We are disappointed as this is not the outcome we and everyone involved in the trial had hoped and worked for over so many years. To save lives, we will require a better screening test that detects ovarian cancer earlier and in more women than the multimodal screening strategy we used.”
Blood test screening picked up 39% more cancers at stage I and II but detected 10% fewer late-stage cancers compared to the no screening group. There was no difference in the stage of cancers detected in the ultrasound group compared to the no screening group.
The initial analysis of deaths in the trial was in 2015, but there was not enough data at that time to conclude whether or not screening reduced deaths. When it was re-examined five years later, the researchers were able to conclude that the screening did not save lives.
Professor Mahesh Parmar, director of the MRC Clinical Trials Unit at UCL and a senior author on the paper, said: “There have been significant improvements in the treatment of advanced disease in the last 10 years, since screening in our trial ended.
“Our trial showed that screening was not effective in women who do not have any symptoms of ovarian cancer; in women who do have symptoms early diagnosis, combined with this better treatment, can still make a difference to quality of life and, potentially, improve outcomes. On top of this, getting a diagnosis quickly, whatever the stage of the cancer, is profoundly important to women and their families.”
Co-investigator Professor Ian Jacobs, from the University of New South Wales (UNSW Sydney), added: “Population screening for ovarian cancer can only be supported if a test is shown to reduce deaths in a future randomised controlled trial.
“I remain hopeful that a new effective screening test will be found eventually, but it will take many years to conduct a large trial of the test.”
The UKCTOCS trial was funded by the NIHR Health Technology Assessment (HTA) Programme, Cancer Research UK and The Eve Appeal.
Menon U, Gentry-Maharaj A, Burnell M et al. General population screening and ovarian cancer mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 13 May 2021
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