Ovarian Cancer Screening

Unlike breast, cervical, and colorectal cancers, there is currently no recommended routine screening test for ovarian cancer in people at average risk who do not have symptoms. Researchers have studied several approaches to ovarian cancer screening, but none has been shown to reliably detect ovarian cancer early enough to reduce the risk of dying from the disease in average-risk populations. This makes understanding your personal risk and recognizing potential symptoms especially important.

Why is ovarian cancer difficult to screen for?

Ovarian cancer can be challenging to detect early. The ovaries are located deep within the pelvis, so small tumors usually cannot be felt from outside the body. Early ovarian cancer can also cause few symptoms or symptoms that can easily be mistaken for common digestive, urinary, or gynecologic conditions. Unlike cervical cancer, ovarian cancer also does not have a known precancerous stage that can routinely be identified and treated through screening. Researchers continue to study new ways to detect ovarian cancer earlier.

Is a pelvic exam an ovarian cancer screening test?

A pelvic exam allows a healthcare provider to examine the reproductive organs and may occasionally identify an enlarged ovary or pelvic mass. However, pelvic exams generally cannot detect small ovarian tumors and are not considered an effective screening test for ovarian cancer. Routine gynecologic care remains important for your overall health, but a normal pelvic exam does not rule out ovarian cancer.

Can a Pap test detect ovarian cancer?

No. A Pap test does not screen for ovarian cancer. Pap tests collect cells from the cervix to look for abnormal cervical cell changes that could lead to cervical cancer. HPV testing also evaluates the risk of cervical cancer. These tests are important for cervical cancer prevention and screening, but they are not designed to detect ovarian cancer.

What is a CA-125 blood test?

CA-125 is a protein that can be measured through a blood test. Some people with ovarian cancer have elevated levels of CA-125. However, CA-125 is not accurate enough to be used by itself as a routine ovarian cancer screening test. There are several reasons for this:

• Some people with ovarian cancer have normal CA-125 levels, particularly with certain types or earlier-stage disease.

• Many noncancerous conditions can raise CA-125 levels.

• CA-125 levels can also be elevated with menstruation, endometriosis, uterine fibroids, pregnancy, and other conditions.

CA-125 is more commonly used to help evaluate certain concerning findings or to monitor some people who have already been diagnosed with ovarian cancer.

What is a transvaginal ultrasound?

A transvaginal ultrasound (TVUS) uses a small ultrasound probe placed inside the vagina to create images of the ovaries, uterus, fallopian tube region, and surrounding structures. Ultrasound can identify ovarian masses and provide information about their size and appearance. However, ultrasound cannot always determine whether a mass is cancerous or benign. Studies have not shown that routine transvaginal ultrasound screening reduces ovarian cancer deaths among average-risk people. For this reason, TVUS is not recommended as a routine ovarian cancer screening test for people at average risk without symptoms.

Should people at high risk be screened?

People with a significantly increased inherited risk of ovarian cancer require individualized care. This can include people with:

• BRCA1 or BRCA2 variants

• Lynch syndrome

• Certain other inherited genetic changes

• A strong family history of ovarian or related cancers

Depending on the situation, a specialist may discuss CA-125 testing and transvaginal ultrasound. However, these tests have important limitations and have not been proven to reliably prevent ovarian cancer deaths through early detection. For people with certain high-risk inherited genetic changes, risk-reducing surgery to remove the fallopian tubes and ovaries is generally a more effective risk-reduction strategy than relying on screening alone.

If you have a strong family history of cancer, ask your healthcare provider whether you should meet with a genetic counselor or gynecologic specialist.

Know the symptoms of ovarian cancer

Because there is no effective routine screening test, recognizing persistent changes in your body is particularly important. Potential symptoms of ovarian cancer include:

• Abdominal or pelvic pain

• Bloating

• Feeling full quickly when eating

• Difficulty eating

• Increased abdominal size

• Urinary urgency or frequency

• Changes in bowel habits, including constipation

• Unexplained weight loss or weight gain

• Fatigue

• Back pain

• Abnormal vaginal bleeding

These symptoms are common and are usually caused by conditions other than ovarian cancer. However, symptoms associated with ovarian cancer may be new, persistent, occur frequently, or represent a noticeable change from what is normal for you. If symptoms continue or become more frequent, talk with a healthcare provider.

What happens if ovarian cancer is suspected?

If you develop symptoms or your healthcare provider identifies a concerning finding, testing is no longer considered routine screening. Instead, your healthcare team will perform a diagnostic evaluation to determine what is causing the problem. Depending on your symptoms and medical history, this may include:

• A physical and pelvic examination

• Transvaginal or abdominal ultrasound

• Blood tests, which may include CA-125

• CT, MRI, or other imaging

• Referral to a gynecologist or gynecologic oncologist

Having an ovarian mass or elevated CA-125 does not automatically mean you have ovarian cancer. Many ovarian masses are benign.

The bottom line

There is currently no reliable routine screening test for ovarian cancer for people at average risk who do not have symptoms. Pap tests do not detect ovarian cancer, and CA-125 blood tests and transvaginal ultrasounds are not recommended as routine screening for average-risk individuals.

If you have a strong family history of ovarian, breast, pancreatic, prostate, colorectal, or endometrial cancer, talk with your healthcare provider about whether you could have an increased hereditary risk.

Because routine screening is not available, knowing your risk and paying attention to persistent symptoms are important. If you notice new or ongoing bloating, pelvic or abdominal pain, difficulty eating, feeling full quickly, or urinary changes, talk with your healthcare provider.