Screening for early ovarian cancer.

There are 20,000 new cases of ovarian cancer per year and over 12,000 deaths in the United States. Seventy percent of women with ovarian cancer have advanced disease at diagnosis, and 5-year survival is less than 30%. Earlier diagnosis is essential to improve prognosis. Risk factors include age, race, ovulation, and family history. New techniques for possible earlier diagnosis include endovaginal color flow ultrasound (US) and measurement of a serum tumor marker, CA 125. CA 125 is only 25% sensitive for early disease and is nonspecific: In premenopausal women, more than 90% of findings are false-positive. Endovaginal color flow US provides superb morphologic detail of malignancy such as mural nodules and solid vascularized components. Low impedance flow has been reported in many cancers but may also be seen in benign masses and in luteal flow. There are technical and economic impediments to earlier diagnosis of ovarian cancer, and more sensitive and specific tumor markers may be required. Current techniques may show only acceptable cost-effectiveness in women at elevated risk by virtue of a family history of the disease.