Early detection of ovarian cancer does not translate into saving lives

Researchers in the UK have established that although a method of screening can detect ovarian cancer early and before women develop symptoms, it does not translate into saving lives.

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) tested two different screening methods but found no evidence that either screening approach reduced deaths from ovarian cancer, compared to no screening.

The study into the long-term impact of screening on ovarian cancer mortality spanned three decades and involved 200,000 postmenopausal women.

Professor Ian Jacobs, Vice-Chancellor of the University of New South Wales (UNSW), has led the ovarian cancer screening research programme since 1985 and was the Lead Investigator of UKCTOCS from 2001-2014.

‘“My thanks to the thousands of women, healthcare professionals and researchers who made this trial possible. The multimodal screening strategy did succeed in detection of ovarian cancer at an earlier stage, but sadly that did not save lives. This is deeply disappointing and frustrating given the hope of all involved that we would save the lives of thousands of women who are affected by ovarian cancer each year.”

Population screening for ovarian cancer can only be supported if a test is shown to reduce deaths in a future randomized controlled trial. I remain hopeful that a new effective screening test will be found eventually, but it will take many years to conduct a large trial of the test. Realistically, this means we have to reluctantly accept that population screening for ovarian cancer is more than a decade away.”

Ian Jacobs, Professor and Vice-Chancellor, University of New South Wales

In Australia, more than 1500 women are diagnosed with ovarian cancer each year. Most are not diagnosed until the disease is in a late stage.

UKCTOCS was designed to test the hypothesis that a reliable screening method that picks up the cancer earlier, when treatments are more likely to be effective, could save lives.

The results of the trial, recently published in The Lancet, looked at data from women whose progress was followed up for an average of 16 years. Women aged between 50 and 74 were enrolled in the trial between 2001 and 2005, screening continued until 2011 and followed up until 2020.  The women were randomly allocated to one of three groups: no screening, screening in the form of an annual ultrasound scan, and annual ‘multimodal’ screening involving a blood test as an initial test followed by ultrasound as a second test.  

"This was a very large trial conducted with rigor and with enormous attention to detail but showed the number of deaths from ovarian cancer was not significantly reduced between the screened and unscreened groups."

'Although multimodal screening found more women with earlier stage disease, this did not lead to lives saved. We therefore cannot recommend ovarian cancer screening for the general population using these methods.'

Prof. Jacobs said the study, one of the largest undertaken in the UK, has advanced medicine’s understanding of ovarian cancer as well as other diseases. He said the UKCTOCS team has created a rich resource of data for researchers who will now continue the work on ovarian cancer.

'The research must continue,’ he stressed, ‘and I urge funding agencies and charities to keep supporting this vital mission.’

‘We now better understand the natural history of the disease, have created a template for large, randomized trials, and can build models of what is required of new screening tests.’

Prof. Jacobs said significant research is also being done on other cancers and diseases, such as cardiovascular disease, using the samples from the UKCTOCS study.

The research had its genesis in 1985 when Prof. Jacobs, at that time a newly graduated doctor, worked with a women’s cancer surgeon in Royal London Hospital in London’s east end. Here he saw women diagnosed with ovarian cancer enter the operating theatre filled with hope, only to return to the clinic months or years later with a recurrence of the cancer.

‘That, to me, was heartbreaking.’

‘The fact that most of the cancers were only diagnosed in later stages of ovarian cancer gave women such a small chance of survival beyond five years after diagnosis.’

There began a more than 30-year journey to find an effective screening test.

Research does not always give you the results you strive for, but it is never futile. Every stage of this trial brought us closer to understanding ovarian cancer and I take comfort in the knowledge that we have given researchers who take the mantle from the UKCTOCS team a substantial head start.’

Ian Jacobs

Prof. Jacobs said the UKCTOCS story is one of enormous passion and goodwill and he thanked Professor Usha Menon, Lead Investigator of UKCTOCS, his co-collaborators, those who funded the research including the Eve Appeal, Cancer Research UK, the Medical Research Council and the NHS, and most of all the women who volunteered for the trial.