Screening for gynecologic malignancies In the last issue, we talked about screening for endometrial cancer, and today we will talk about screening for ovarian cancer, the king of gynecologic tumors. Ovarian cancer is a kind of gynecological tumor with high malignancy, and because it is often found at an advanced stage, it ranks first in the mortality rate of gynecological cancers, and is truly the king of gynecological cancers. If ovarian cancer can be detected early and treated in time, it can achieve very good treatment results. For example, the 5-year survival rate of early-stage ovarian cancer (stage I) can reach 80-90% after treatment, but once it reaches advanced stage (stage III and IV), it rapidly decreases to 30-40% or even lower. Because ovarian cancer is asymptomatic in early stages, early detection is difficult. So, people thought whether they could screen for early stage ovarian cancer by these modern medical means such as blood sampling and ultrasound? The answer is: There is no effective screening means to face this dreadful gynecological cancer! Doctor, you are not right, are you? I heard that CA125 and ultrasound can detect ovarian cancer, right? In fact, doctors have long thought of using various methods alone or in combination to detect ovarian cancer at an early stage. But what are the results? CA125 is elevated in some ovarian epithelial cancers, but the rate of elevation in early stage patients is less than 50%. Moreover, CA125 is also found in many cases, such as pregnancy, infection, liver disease, endometriosis, lung cancer, breast cancer, and endometrial cancer, so there are too many cases of elevated CA125; and early-stage ovarian cancer often does not have high CA125, so CA125 cannot be used as a screening tool alone. Ultrasound: It seems to be a reasonable idea to have frequent ultrasound to see if there are tumors in the ovaries. The problem is that it is difficult to tell the difference between early-stage ovarian cancer and common ovarian disease with ultrasound. If an ultrasound detects a mass in the ovary, it does not mean that it is ovarian cancer, and more often than not, it will lead to unnecessary tests and even surgery. Surgery is risky! Since CA125 and ultrasound cannot be used alone, can they be used in combination? A famous large-scale clinical study in the United States (PLCO study) found that among as many as 228,816 healthy women screened by CA125+B ultrasound, 60% of ovarian cancers were still missed. More importantly, this approach did not reduce the mortality rate of ovarian cancer. Based on the above findings, many international authorities, such as the National Comprehensive Cancer Network (NCCN), the United States Preventive Services Task Force (USPSTF), and our Chinese Society of Gynecologic Oncology, do not recommend screening for ovarian cancer in healthy, asymptomatic women. There are some women who are at high risk for ovarian cancer, including: family history of ovarian cancer, especially those with ovarian cancer gene mutations in their immediate family, especially those with BRCA1/2 gene mutation syndrome. In conclusion, ovarian cancer screening is not recommended for the general population; there is no good screening method.