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Medscape
4 days ago
- Health
- Medscape
Rapid Review Quiz: Ovarian Cancer Screening and Prevention
Reliably screening for ovarian cancer in the general population remains a challenge. Common tools such as CA-125 testing and transvaginal ultrasound have shown limited sensitivity and specificity, leading to unnecessary surgeries and false reassurance. However, advances in genetic testing and molecular pathology have reshaped prevention strategies, particularly in individuals at elevated hereditary risk such as BRCA mutation carriers. Risk-reducing salpingo-oophorectomy remains the cornerstone of prevention for high-risk patients, while oral contraceptives offer a risk-reducing effect in the general population. Additionally, genetic counseling has become an essential step in identifying at-risk individuals who may benefit from tailored interventions. How much do you know about recent developments in ovarian cancer screening and prevention? Test your knowledge with this updated review. Despite significant research efforts, no screening strategy has yet demonstrated a mortality benefit in average-risk female patients. As noted in the National Comprehensive Cancer Network (NCCN) guidelines, landmark clinical trials — including the PLCO (Prostate, Lung, Colorectal, and Ovarian) cancer screening trial — failed to show a survival benefit from annual CA-125 testing or transvaginal ultrasound alone or in combination. The risk of ovarian cancer algorithm (ROCA) — which evaluates CA-125 trends over time — did improve early-stage detection rates but did not ultimately reduce mortality. As a result, current guidelines from the United States Preventive Services Task Force and other expert bodies, including the NCCN, recommend against routine screening for ovarian cancer in asymptomatic, average-risk females. Instead, attention has shifted toward identifying and managing high-risk individuals through genetic counseling and risk-reducing strategies. Routine screening in the general population is considered ineffective and may result in harms from false-positive tests and unnecessary surgical interventions. Learn more about the workup for ovarian cancer. Risk-reducing salpingo-oophorectomy (RRSO) remains the most effective strategy for preventing ovarian and fallopian tube cancer in individuals with BRCA1 or BRCA2 mutations. Guidelines recommend RRSO typically between ages 35 and 45, depending on the specific mutation and family history. This surgery significantly lowers the risk of high-grade serous carcinoma, the most common and aggressive subtype. Studies have shown that RRSO can reduce ovarian cancer risk significantly also confer a survival benefit, particularly in BRCA1 carriers. While oral contraceptives also reduce risk, they do not offer the same degree of protection as surgical removal of at-risk tissue. Annual pelvic exams and imaging have not demonstrated efficacy in early detection or mortality reduction in this population. Patients considering RRSO should be counseled about surgical menopause and may require hormone therapy depending on age and symptom burden. The procedure is essential in the preventive care of high-risk individuals. Learn more more about ovarian cancer deterrence and prevention. Emerging evidence over the past decade suggests that the fallopian tube epithelium — not the ovary — is the origin of many high-grade serous ovarian carcinomas. As a result, the practice of opportunistic salpingectomy — removing the fallopian tubes during hysterectomy or tubal sterilization procedures — has gained traction as a preventive strategy, even in females at average risk. Major gynecologic societies now endorse this practice as a safe and effective risk-reducing option during pelvic surgery for benign indications. The rationale is grounded in the theory of serous tubal intraepithelial carcinoma as a precursor lesion to high-grade serous cancer. Unlike endometrial cancer, whose origin lies in the uterine lining, salpingectomy directly targets the tissue where most serous carcinomas are thought to begin. Learn more about ovarian cancer and surgical considerations. Current guidelines recommend genetic counseling and consideration of BRCA and multigene panel testing in females with a personal or strong family history of breast, ovarian, fallopian tube, or peritoneal cancer. Identifying carriers of pathogenic variants enables implementation of life-saving risk-reducing strategies, including salpingo-oophorectomy or enhanced surveillance. Importantly, such testing is also offered to individuals with male relatives who have had breast cancer, early-onset cancers, or known mutations in cancer susceptibility genes. Genetic testing should ideally be preceded by counseling to interpret results accurately and discuss implications for family members. Patients with unrelated gynecologic conditions like endometriosis or abnormal uterine bleeding, and those without relevant family history, are not routinely offered genetic testing unless other risk factors emerge. Early identification of mutation carriers is essential for tailored management, timely preventive interventions, and cascade testing of at-risk relatives. Learn more about risk assessment and genetic counseling in ovarian cancer. Multiple large observational studies and meta-analyses have consistently demonstrated a protective effect of combined oral contraceptives (COCs) against ovarian cancer. The reduction in risk is observed with long-term use, typically over 5 years, and persists for decades after discontinuation. The proposed mechanism involves suppression of ovulation, thereby reducing the repetitive trauma and repair cycles to the ovarian epithelium, which may underlie carcinogenesis. The protective effect spans multiple histologic subtypes, including high-grade serous, endometrioid, and clear cell carcinomas. While other agents such as NSAIDs have been evaluated, their protective role is less well established and not considered standard for chemoprevention. Aromatase inhibitors and bisphosphonates are not used for ovarian cancer prevention. As with any medication, the decision to use oral contraceptives must consider individual risk profiles, including thromboembolic and cardiovascular risks, and be guided by patient preferences and shared decision-making. Learn more about ovarian cancer and the impact of oral contraceptives.
20-05-2025
- Health
Biden last had a prostate cancer antigen blood test in 2014, spokesperson says
A representative for former President Joe Biden said he last took a prostate-specific antigen blood test, commonly used to screen for prostate cancer, in 2014. Although the exact date of the test wasn't disclosed, Biden was around 72 years old at the time, which falls in line with current medical guidance and recommendations on who should take a test. Current screening recommendations suggest men age 55 to 69 should discuss the benefits and harms of a PSA test with their doctor and make an individual decision when or if they need it. Men 70 and older should not receive PSA-based screening because of the risk of false positives, according to the United States Preventive Services Task Force. "Prior to Friday, President Biden had never been diagnosed with prostate cancer," the spokesperson said in a statement. Biden announced Sunday that he had an aggressive form of prostate cancer that had spread to his bones. A PSA screening is not a perfect test, medical experts say. The older a person is, the more the risk of false positives and unnecessary biopsies increases. Conversely, some people with cancer might have good PSA scores. PSA screening is highly debated among doctors in terms of when it's appropriate to use. Biden's representatives said the former president had a routine physical last week and doctors discovered a small nodule in his prostate. Since his diagnosis was revealed two days ago, President Donald Trump questioned the timing of the announcement and claimed that "somebody is not telling the facts." "I'm surprised that it wasn't, you know -- the public wasn't notified a long time ago because to get to stage nine -- that's a long time," Trump said Monday.
Yahoo
06-04-2025
- Health
- Yahoo
Oklahomans are nearly last in getting early lung cancer screening
The American Cancer Society projects that approximately 124,730 Americans will succumb to lung cancer in 2025. This number exceeds the combined expected deaths from the next three most common types of cancer: prostate, breast and colon. Significant efforts are still required to raise awareness about lung cancer and the importance of lung cancer screening, with the goal of improving outcomes at both state and national levels. It is estimated that 3,200 individuals will be diagnosed with lung cancer annually in Oklahoma. Early-stage detection significantly improves long-term survival rates compared to later-stage diagnoses. However, 43% of lung cancer cases in Oklahoma are identified at a later stage, which impacts survival rates negatively. The 5-year survival rate for early-stage lung cancer is approximately 65%, while it is only 9% for lung cancer with distant spread. According to the American Lung Association, Oklahoma ranks 44th out of 47 states where testing has been done in early-stage lung cancer diagnosis and dead last among those 47 states for survival data. This statistic highlights an area with potential for improvement in the future. More: Cuts to Medicaid funding will send 'tidal wave' through Oklahoma's health system | Opinion In recent decades, the survival rate for lung cancer has improved significantly, primarily due to early detection. CT scans for lung cancer screening in high-risk individuals can assist in detecting lung cancer at an earlier stage, thereby enhancing survival rates. The United States Preventive Services Task Force (USPSTF) currently recommends lung cancer screening for individuals who meet the following criteria: Have smoked one pack per day for 20 years or more, Have smoked within the last 15 years, and Are between the ages of 50 and 80. The American Lung Association states that lung cancer screening scans can reduce lung cancer mortality rates by 20%. Enhancing lung cancer screening rates is crucial to improving lung cancer survival both statewide and nationally. The national rate for lung cancer screening within the affected population is approximately 16.5%, whereas, regrettably, Oklahoma ranks last among all 50 states with a screening rate of about 9% in the qualifying population. This disparity presents a significant opportunity to enhance lung cancer screenings and subsequently reduce mortality rates in the coming years. Cigarette smoking is a significant risk factor for lung cancer, with 80-90% of cases attributable to it. The continuous decline in cigarette smoking in the United States is anticipated to decrease the number of future lung cancer incidences. Extensive efforts have been made in Oklahoma to promote tobacco cessation, and complementary resources are available at 1-800-QUIT-NOW for individuals who wish to cease smoking. If you believe that you or your loved ones may qualify for lung cancer screening, it is important to consult with your physician. A collaborative approach is essential to enhance lung cancer outcomes in Oklahoma, contributing to a healthier community. Samid M. Farooqui is a pulmonary critical care physician from Oklahoma City. This article originally appeared on Oklahoman: Early screening could improve cancer survival rate in OK| Opinion
