NEW YORK (Reuters Health), Dec 26 - Annual screening by transvaginal ultrasound and CA125 measurement does not reliably detect early-stage ovarian cancer, according to a report in the December issue of BJOG: An International Journal of Obstetrics and Gynecology.
"We and other groups confirm that the current method of ovarian screening, which is a combination of ultrasound scans and serum markers, is ineffective," Dr. Emma R. Woodward from Birmingham Women's Hospital, UK, told Reuters Health. "Therefore, for women at high risk of developing ovarian cancer, the only real option at present to prevent ovarian cancer death is to have the ovaries removed as a preventive measure."
In a retrospective study, Dr. Woodward and colleagues assessed the effectiveness of ovarian cancer screening with transvaginal ultrasound (TVU) and CA125 in 341 asymptomatic women with a family history of ovarian cancer.
Out of 1084 surveillance TVU, 929 (85.7%) were normal and 155 (14.3%) were abnormal, the authors report. Only 18 (2.1%) of 875 surveillance CA125 measures were abnormal.
Fifty-seven women (16.7%) underwent prophylactic ovariectomy, the report indicates, and 30 of the remaining women had exploratory surgery following abnormal surveillance TVU or CA125.
Four ovarian cancer cases occurred in the cohort. Only one was detected at surgery for abnormal screening results and it was classified FIGO stage III/IV, the researchers note. In the other three cases, the women presented symptomatically between screenings.
Based on these findings, TVU was only 33.3% sensitive and CA125 was only 50% sensitive for detecting ovarian cancer in high-risk women. The combination of TVU and CA125 was 50% sensitive and 82.8% specific for detecting ovarian cancer.
"By entering such a screening program, healthy women may have exploratory surgery because of false-positive findings, thereby putting themselves at risk of potential surgical complications," Dr. Woodward pointed out. "Furthermore, the few women who do develop ovarian cancer are unlikely to be diagnosed at an early stage when the disease is curable."
She concluded: "For those who are not at high risk, ovarian cancer screening should not be offered unless it is within a clinical trial aimed at developing new methods for ovarian screening."
By Will Boggs, MD
Last Updated: 2007-12-26 9:03:04 -0400 (Reuters Health)
BJOG 2007;114:1500-1509.
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
