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Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening

van Nagell, John R. Jr, MD; Burgess, Brian T., DO, PhD; Miller, Rachel W., MD; Baldwin, Lauren, MD; DeSimone, Christopher P., MD; Ueland, Frederick R., MD; Huang, Bin, DrPh; Chen, Quan, DrPh; Kryscio, Richard J., PhD; Pavlik, Edward J., PhD

doi: 10.1097/AOG.0000000000002921
Contents: Cancer: Original Research
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OBJECTIVE: To estimate the effect of ultrasound screening on stage at detection and long-term disease-specific survival of at-risk women with epithelial ovarian cancer.

METHODS: Eligibility included all asymptomatic women 50 years of age or older and women 25 years of age or older with a documented family history of ovarian cancer. From 1987 to 2017, 46,101 women received annual ultrasound screening in a prospective cohort trial. Women with a persisting abnormal screen underwent tumor morphology indexing, serum biomarker analysis, and surgery.

RESULTS: Seventy-one invasive epithelial ovarian cancers and 17 epithelial ovarian tumors of low malignant potential were detected. No women with a low malignant potential tumor experienced recurrent disease. Stage distribution for screen-detected invasive epithelial ovarian cancers was stage I—30 (42%), stage II—15 (21%), stage III—26 (37%), and stage IV—0 (0%). Follow-up varied from 9.2 months to 27 years (mean 7.9 years). Disease-specific survival at 5, 10, and 20 years for women with invasive epithelial ovarian cancer detected by screening was 86±4%, 68±7%, and 65±7%, respectively, vs 45±2%, 31±2%, and 19±3%, respectively, for unscreened women with clinically detected ovarian cancer from the same geographic area who were treated at the same institution by the same treatment protocols (P<.001). Twenty-seven percent of screen-detected malignancies were type I and 73% were type II. The disease-specific survival of women with type I and type II screen-detected tumors was significantly higher than that of women with clinically detected type I and type II tumors and was related directly to earlier stage at detection.

CONCLUSION: Annual ultrasound screening of at-risk asymptomatic women was associated with lower stage at detection and increased 5-, 10-, and 20-year disease-specific survival of women with both type I and type II epithelial ovarian cancer.

CLINICAL TRIAL REGISTRATION: OnCore Clinical Trials Management System, NCI-2013-01954.

Ultrasound screening of asymptomatic at-risk women is associated with a lower stage at detection and increased long-term survival of epithelial ovarian cancer.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, Kentucky.

Corresponding author: John R. van Nagell Jr, MD, Division of Gynecologic Oncology, University of Kentucky-Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293; email:

Supported by research grants from the Kentucky Department of Health and Human Services and the Telford Foundation.

Financial Disclosure The authors did not report any potential conflicts of interest.

Dr. van Nagell is an American Cancer Society Professor of Clinical Oncology.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 10, 2018

Received in revised form June 28, 2018

Accepted July 12, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.