Significant reduction in mortality with multimodal screening when prevalent cases excluded
THURSDAY, Dec. 17, 2015 (HealthDay News) — The efficacy of ovarian cancer screening is unclear, with no significant reduction in mortality in primary analysis, according to a study published online Dec. 17 in The Lancet.
Ian J. Jacobs, M.B.B.S., from University College London, and colleagues estimated the effect of early detection by screening on ovarian cancer mortality. Postmenopausal women aged 50 to 74 years from 13 centers were recruited. A total of 202,638 women were considered eligible and randomized to one of three groups: annual multimodal screening (MMS) with serum CA125 interpreted with use of the risk of ovarian cancer algorithm (50,640 women), annual transvaginal ultrasound screening (USS; 50,639 women), or no screening (101,359 women). More than 99.9 percent of women in all groups were eligible for analysis.
The researchers found that ovarian cancer was diagnosed in 0.6 percent of women at a median follow-up of 11.1 years: 0.7 percent in the MMS group, 0.6 percent in the USS group, and 0.6 percent in the no screening group. Of these women, 0.29, 0.30, and 0.34 percent, of women in the MMS, USS, and no screening groups, respectively, had died of ovarian cancer. Over years 0 to 14, there was a mortality reduction of 15 percent with MMS (P = 0.10) and 11 percent with USS (P = 0.21). With exclusion of prevalent cases, MMS versus no screening showed a significantly different death rate (P = 0.021), with an overall mortality reduction of 20 percent, and a reduction of 8 percent in years 0 to 7 and 28 percent in years 7 to 14 in favor of MMS.
“Although the mortality reduction was not significant in the primary analysis, we noted a significant mortality reduction with MMS when prevalent cases were excluded,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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