More men die from prostate cancer than women die from breast cancer and cervical cancer. There’s no national screening programme for prostate cancer – not even plans for one – but there have long been programmes for breast cancer and cervical cancer, despite the apparent futility of the latter. A piece in today’s Telegraph:
Results of trials were ‘very depressing indeed’, say experts battling disease that is often diagnosed only at a late stage
Screening for ovarian cancer does not lead to a reduction in deaths, a Lancet study has found, ending hopes of saving more lives through a national programme.
Around 4,000 women die from ovarian cancer every year in the UK, with the disease more often diagnosed at a late stage meaning it is harder to treat.
The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), which began screening women in 2001, tested the theory that reliable screening that picks up ovarian cancer early could save lives.
But data gathered from more than 200,000 women over an average of 16 years suggested screening the general population “cannot be recommended”, the experts said.
The women were randomly allocated to three groups; no screening, annual screening using an ultrasound scan, and annual multimodal screening involving a blood test.
Blood test screening – which monitored changes in the level of the protein CA125 – picked up almost two fifths of early stage cancers, but detected 10 per cent fewer late-stage cancers compared with the no-screening group.
No difference in the stage of cancers was detected between the ultrasound group and the no-screening group.
Despite finding more early stage cancers in the multimodal group there was “no evidence of a difference over a reduction in ovarian cancer deaths in the multimodal or ultrasound groups compared to the no-screening group”, Prof Mahesh Parmar, director of the MRC Clinical Trials Unit at UCL and a senior author on the paper, said.
“We cannot recommend general population screening for ovarian cancer for routine practice,” he added. [J4MB emphasis]
Prof Usha Menon, lead investigator at the UKCTOCS, said: “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.”
Currently, there is no national screening programme for ovarian cancer on the NHS and the results of the trial were expected to inform any decision to create one.
Asked why screening did not lead to a reduction in deaths, Prof Parmar told reporters that more women needed to be identified at an early stage.
He added: “This disease is such that even if you did that… it’s going to be aggressive whatever you do.
“Even if you find it at an early stage, there is an indication that (death) might be the case for some women and if that is the case that would be very depressing indeed”.
Participants in the trial, who were aged between 50 and 74, were enrolled between 2001 and 2005, and screened until 2011.
The initial analysis of deaths in the trial occurred in 2015, but there was not enough data at that time to conclude whether screening reduced deaths so it was decided to do five more years of follow-up data.
Prof Menon said since 2011 there had been “significant advances” in treatments for ovarian cancer. But Prof Parmar added those advances had been for late-stage cancers with “relatively little change” for early-stage cancers.
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