Physicians self-report overuse of ovarian cancer screening while recommended cancer screening remains underused

Many physicians report screening low- and medium-risk women for ovarian cancer despite evidence-based guidelines recommending against routine screening, a new study found.
Researchers sent 3,200 family physicians, general internists and obstetrician-gynecologists a questionnaire with vignettes about women's annual examinations. The responses of 1,088 physicians were included in the study. Physicians were asked about their use of transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125), neither of which is recommended as an effective screening tool by current guidelines. The results appear in the Feb. 7 Annals of Internal Medicine.
When asked about their screening practices for low-risk women, 28% of the physicians said they would order the tests at least sometimes, and 65.4% would use them for women at medium risk for ovarian cancer. Smaller percentages reported routinely using the tests for these patients (6% for low-risk women and 24% for medium-risk). However, a full third of the surveyed physicians believed that the TVU or CA-125 was an effective screening test.
Evidence-based reviews have documented that both tests cause more harm than benefit, the study authors noted. Multiple professional societies and the U.S. Preventive Services Task Force (USPSTF) have publicly concluded that ovarian cancer screening incurs more risk than benefit for low- and medium-risk women, the researchers added. Extrapolating their findings over the population of the U.S., they concluded that as many as 1.2 million women may be unnecessarily screened at a potential cost of $18 to $360 million.
Younger physicians, those in group practices, and physicians who listed the USPSTF as one of their main sources of screening recommendations were less likely to screen excessively, the study found. The authors noted that the USPSTF has issued more declarative guidelines on the subject than other organizations. The American Cancer Society, for example, does not publish ovarian cancer screening guidelines. The authors called for wider dissemination of guidelines and interventions that encourage interaction between diverse physicians to remedy this problem.
In contrast, screening rates for several other types of cancer are still falling short of Healthy People 2020 targets, according to an analysis from the Centers for Disease Control and Prevention, published in the Jan. 27 Morbidity and Mortality Weekly Report.
The USPSTF recommends mammography every two years for women 50 to 74, and the goal is to have 81.1% of eligible patients screened by 2020. However, according to the 2010 National Health Interview Survey (NHIS), the breast cancer screening rate was only 72.4%, which represented no improvement over year 2000 statistics. For cervical cancer, the recommendation was a Pap test every three years for women 21 to 65, and the goal was screening 93% of the population. The 2010 NHIS found a rate of 83%, which was a slight drop from 2000.
Colorectal cancer screening rates improved over the decade but still fell short of the goal of 70.5%. Overall, 58.6% of respondents between the ages of 50 and 75 met the recommendation of having 1) annual high-sensitivity fecal occult blood testing (FOBT), 2) sigmoidoscopy every five years combined with FOBT every three years, or 3) colonoscopy every 10 years. Asian people were less likely to have received any type of screening and Hispanic patients were less likely to have received cervical or colorectal screening. The researchers called for overall improvements in the use of the tests as well as efforts targeted at particularly underscreened populations.