Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening

Abstract

Objective: To estimate the effect of ultrasound screening on stage at detection and long-term disease-specific survival of at-risk women with epithelial ovarian cancer.

Methods: Eligibility included all asymptomatic women 50 years of age or older and women 25 years of age or older with a documented family history of ovarian cancer. From 1987 to 2017, 46,101 women received annual ultrasound screening in a prospective cohort trial. Women with a persisting abnormal screen underwent tumor morphology indexing, serum biomarker analysis, and surgery.

Results: Seventy-one invasive epithelial ovarian cancers and 17 epithelial ovarian tumors of low malignant potential were detected. No women with a low malignant potential tumor experienced recurrent disease. Stage distribution for screen-detected invasive epithelial ovarian cancers was stage I-30 (42%), stage II-15 (21%), stage III-26 (37%), and stage IV-0 (0%). Follow-up varied from 9.2 months to 27 years (mean 7.9 years). Disease-specific survival at 5, 10, and 20 years for women with invasive epithelial ovarian cancer detected by screening was 86±4%, 68±7%, and 65±7%, respectively, vs 45±2%, 31±2%, and 19±3%, respectively, for unscreened women with clinically detected ovarian cancer from the same geographic area who were treated at the same institution by the same treatment protocols (P<.001). Twenty-seven percent of screen-detected malignancies were type I and 73% were type II. The disease-specific survival of women with type I and type II screen-detected tumors was significantly higher than that of women with clinically detected type I and type II tumors and was related directly to earlier stage at detection.

Conclusion: Annual ultrasound screening of at-risk asymptomatic women was associated with lower stage at detection and increased 5-, 10-, and 20-year disease-specific survival of women with both type I and type II epithelial ovarian cancer.

Clinical trial registration: OnCore Clinical Trials Management System, NCI-2013-01954.

Fig. 1.

Study algorithm, University of Kentucky Ovarian Cancer Screening Trial. van Nagell. Ovarian Cancer Screening. Obstet Gynecol 2018.

Fig. 2.

Flow diagram of women undergoing ovarian cancer screening. van Nagell. Ovarian Cancer Screening. Obstet Gynecol 2018.

Fig. 3.

Kaplan-Meier disease-specific survival of screened and unscreened women with epithelial ovarian cancer by life table method. Screened women (n=71; 5-, 10-, and 20-year survival is 86±4%, 68±7%, and 65±7%, respectively). Unscreened women with clinically detected ovarian cancers treated at the University of Kentucky-Markey Cancer Center (n=921; 5-, 10-, and 20-year survival is 45±2%, 31±2%, and 19±3%, respectively), P<.001. P value obtained by the log-rank test. Vertical lines indicate censored points. van Nagell. Ovarian Cancer Screening. Obstet Gynecol 2018.

Fig. 4.

Kaplan-Meier disease-specific survival of women according to type of epithelial ovarian cancer by life table method. A. Women with screen-detected type I ovarian cancers (n=19; 5-, 10-, and 20-year survival is 83±9%, 83±9%, and 83±9%, respectively) and women with clinically detected type I ovarian cancers that were treated at the University of Kentucky-Markey Cancer Center (n=319; 5-, 10-, and 20-year survival is 69±3%, 58±4%, and 39±5%, respectively), P<.05. B. Women with screen-detected type II ovarian cancer (n=52; 5-, 10-, and 20-year survival is 88±5%, 63±9%, and 57±10%, respectively) and women with clinically detected type II ovarian cancers treated at the University of Kentucky-Markey Cancer Center (n=589; 5-, 10-, and 20-year survival is 34±2%, 18±2%, and 7±4%, respectively), P<.001. P values obtained by the log-rank test. Pathology was inadequate for type I compared with II designation in 13 clinically detected cases. Vertical lines indicate censored points. van Nagell. Ovarian Cancer Screening. Obstet Gynecol 2018.

Fig. 5.

Kaplan-Meier disease-specific survival of women with screen-detected and clinically detected epithelial ovarian cancers according to stage by life table method. A. Women with screen-detected, early-stage ovarian cancer (n=45; 5-, 10-, and 20-year survival is 93±4%, 81±7%, and 81±7%, respectively) and women with screen-detected, late-stage ovarian cancer that were treated at the University of Kentucky-Markey Cancer Center (n=26; 5-, 10-, and 20-year survival is 75±9%, 46±13%, and 37±13%, respectively), P<.05. B. Women with clinically detected, early-stage ovarian cancers (n=276; 5-, 10-, and 20-year survival is 76±3%, 67±3%, and 48±5%, respectively) and women with clinically detected, late-stage ovarian cancer treated at the University of Kentucky-Markey Cancer Center (n=645; 5-, 10-, and 20-year survival is 28±2%, 13±2%, and 3±2%, respectively), P<.001. P values obtained by the log-rank test. Vertical lines indicate censored points. van Nagell. Ovarian Cancer Screening. Obstet Gynecol 2018.