The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer

Since 1987 more than 14,000 women older than 50 years, or older than 25 years with a family history of ovarian cancer, have participated in the University of Kentucky Ovarian Cancer Screening Project. In this program, asymptomatic women were screened with annual sonograms to investigate the ability of annual transvaginal sonography to detect early ovarian cancer. At each annual visit, participants who had an ovarian volume of more than 10 cm in postmenopausal women, more than 20 cm in menopausal women, or papillary or complex tissue projection into a cystic ovarian tumor underwent repeated sonography within 4 to 6 weeks. If the abnormality persisted, serum cancer antigen 125 (CA-125) levels were measured, and tumor morphology indexing and Doppler flow sonography were performed. At this point, the women were advised to have surgical removal of the tumor.Of the 14,469 women enrolled in this project, 180 (1.2 percent) have undergone surgery for removal of an ovarian tumor. Total abdominal hysterectomy with bilateral oophorectomy was performed in patients with ovarian cancer or who had other indications for hysterectomy. Women with benign tumors usually had only unilateral or bilateral salpingo-oophorectomy. Serous cystadenoma was the most frequent diagnosis (in 78 of 180 women), followed by endometrioma (25 of 180). Primary ovarian cancer was found in 17 of the 180 patients. A significant difference was seen between the mean morphology index of benign tumors and malignant tumors (benignmean = 3.8, SD = 2.4, range = 0–12; malignantmean = 6.0, SD = 2.4, range = 2–10; P < .001). No cancer was found in unilocular tumors without wall abnormalities (N = 94). Family history of ovarian cancer was not associated with the diagnosis of ovarian cancer or cystadenoma.Eleven of the 17 ovarian cancers were stage I, 3 were stage II, and 3 were stage III. Serum levels of CA-125 were measured in 7 of the 11 stage I patients; the level of CA-125 was elevated in only 1. Nine of the cancers were found during the first screening; the other eight were detected at subsequent screenings. With 1 to 10 years of follow-up, 15 patients are disease free. Two patients, one with stage IIIB disease and one with stage IIIC disease, have died of ovarian cancer. In both cases the cancer was detected at the first screening and treated aggressively. One patient lived for more than 7 years after her initial diagnosis, and the other lived nearly 2.5 years after diagnosis.In four women ovarian cance