Screening and Prevention of Ovarian Cancer

Abstract

The aim of this study is to review clinical studies for organizing a screening and prevention program for ovarian cancer. A search of the relevant English-language literature published between 1986 and 2016 was conducted using the MEDLINE online database. Several reviews have dealt with ovarian cancer screening in the general populations and specific high-risk groups. The results from the medical literature showed that a variety of screening of ovarian cancer were unable to provide the impact on clinical survival benefit. Although the survival data from the UK study provided a modest degree of hope, at present there is no effective screening test for ovarian cancer. Since ovarian cancer is not a uniform entity, it is unlikely that a single approach to screening will be appropriate for all patients. Clinical guidelines are available for HBOC, which include breast and ovarian cancer screening (surveillance) and risk-reducing interventions (risk-reducing surgical and medical options). Surgical and pharmacological options are available. Prophylactic RRSO and RRM reduced cancer incidence compared to chemoprevention or surveillance, but many women who are at risk for BRCA1/2 mutations delay or decline prophylactic surgery. Oral contraceptives are proposed as a chemoprevention agent for ovarian cancer. Chemoprevention contributes to reducing ovarian cancer deaths, with a special attention on the breast cancer risk. Importantly, a recent meta-analysis demonstrated a significant ovarian cancer risk reduction and no increased breast cancer risk with oral contraceptive use by BRCA mutation carriers. Breast cancer risk may vary by age at first oral contraceptive use, duration of use, intervals from the last use, and oral contraceptive formulation. At present, there is no effective screening for ovarian cancer. Clinicians are recommended to encourage high-risk women who delay or decline risk-reducing surgery to discuss risk-reducing pharmacologic options in order to prevent ovarian cancer progression without elevation of breast cancer risk.