Ovarian Cancer Screening: the Role and Drawbacks of Ultrasonography and Feasibility in Low Resource Settings

摘要

Context: Although there have been reports of increasing incidence of ovarian cancer in developing countries, no developing country has been involved in current trials of ovarian cancer screening. Aim: To review the evolution of the role and drawbacks of ultrasonography in ovarian cancer screening and the feasibility of implementing current potential screening strategies inlow resource settings. Methods: An electronic literature search for all articles written in English language on ovarian cancer screening from 1960-2013. Information from appropriate articles were collated and analysed for content. Results: Ultrasound was used as the first-line or second-line test in the most popular multicentre multimodal trials of ovarian cancer screening. It has a high sensitivity but a low specificity. The low specificity of ultrasound screening necessitates the use of further measures to aid the triaging of ultrasound positive cases, which add to the overall cost of screening. There is yet scant evidence of the cost effectiveness of multimodal screening for ovarian cancer. Current potential strategies for ultrasound-based screening for ovarian cancer demand the training and employment of large numbers of highly skilled personnel as well as the acquisition of high resolution scanners and technology for biochemical assay of tumour markers. Conclusion: Transvaginal ultrasonographyhas evolved into a potentialtool for ovarian cancer screening and ovarian cancer screening strategies based on CA125 assays and ultrasonography would demand substantial resources. If and when reduction in mortality and cost-effectiveness of this approach to screening are proven, itmay not be feasible in developing countries.