Screening for Ovarian Cancer – Fantasy or Reality?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Select the appropriate screening modality when evaluating women for ovarian cancer 2. Identify the clinical settings in which referral to a gyn oncologist and genetic services is recommended
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Epithelial ovarian cancer is generally detected late, with overall five year survival of 20-30%. The search for a cheap, accurate screening test to identify the disease in its early stage has been ongoing for the past few decades. Currently, there is no proven strategy for the early detection of cancer that decreases ovarian cancer mortality.
In the most recent joint Committee Opinion, ACOG and SGO makes the following statement regarding direct-to-consumer marketing of ovarian cancer screening tests
At this time, there is insufficient evidence to support the use of any of these tests or algorithms for the early detection of ovarian cancer in average-risk women. Women considering purchasing these tests, which are currently not approved nor cleared by the U.S. Food and Drug Administration for ovarian cancer screening and are not financially covered by medical insurance, should be counseled on the risks of such tests.
Low Risk and Asymptomatic
Do not use transvaginal ultrasound and tumor markers for ovarian cancer screening
These tests are ineffective, lacking good sensitivity, specificity, and positive predictive value
Including those with a BRCA mutation or a positive family history for ovarian cancer
Refer for genetic services for risk assessment, counseling and management
There is professional guidance regarding ovarian cancer screening for women at high risk which will include biomarker testing and imaging that is regularly reviewed and updated as required
Although ovarian cancer has been described as “silent”, it is not uncommon for women with the disease to have abdominal symptoms. Persistent and progressive bloating, abdominal/pelvic pain, early satiety, appetite loss, urinary urgency, increased abdominal girth should be evaluated with a high index of suspicion for malignancy.
When a pelvic mass has been identified on examination and imaging, consider referral to or consultation with a gynecologic oncologist when
The patient is postmenopausal, the CA-125 is elevated, there is ascites, a nodular or fixed pelvic mass is present, or evidence of metastases
The patient is premenopausal, with a very elevated CA-125, ascites, or evidence of metastases
Staging for ovarian epithelial cancer is surgical and if malignancy is suspected or expected,
Peritoneal cytology should be obtained on entry into the abdomen
The adnexal mass should be removed intact
Liver, spleen, both diaphragms, and all peritoneal surfaces should be inspected and palpated
Traditional staging includes omentectomy, pelvic and para-aortic lymphadenectomy, peritoneal biopsies, removal of uterus and adnexa and all tumor nodules
The uterus and uninvolved ovary can be left in place if the malignancy is confined to one ovary and fertility is desired
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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