Risk of epithelial ovarian cancer in asymptomatic women with ultrasound‐detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS)

• DOI: 10.1002/uog.12270
• Publication Date: 2012-08-22T09:19:37Z
• Authors: A. Sharma; S. Apostolidou; M. Burnell; S. Campbell; M. Habib; A. Gentry‐Maharaj; N. Amso; M. W. Seif; G. Fletcher; N. Singh; E. Benjamin; C. Brunell; G. Turner; R. Rangar; K. Godfrey; D. Oram; J. Herod; K. Williamson; H. Jenkins; T. Mould; R. Woolas; J. Murdoch; S. Dobbs; S. Leeson; D. Cruickshank; E.‐O. Fourkala; A. Ryan; M. Parmar; I. Jacobs; U. Menon
• Keywords: ovarian cancer screening; postmenopausal women; ovarian neoplasm; Carcinoma, Ovarian Epithelial; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Adnexa Uteri; Risk Factors; ovarian cysts; Prevalence; Humans; Neoplasms, Glandular and Epithelial; Prospective Studies; Early Detection of Cancer; risk; Aged; Ultrasonography; Ovarian Neoplasms; ultrasound; borderline ovarian cancer; Ovary; Middle Aged; Type I/II epithelial ovarian cancer; United Kingdom; 3. Good health; Postmenopause; UKCTOCS; Female; Follow-Up Studies

AbstractObjectiveTo estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound.MethodsThis was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasound‐detected abnormal adnexal (unilocular, multilocular, unilocular solid and multilocular solid, solid) morphology on their first scan. Women were followed up through the national cancer registries and by postal questionnaires. Absolute risks of EOC and borderline, Type I and Type II EOC within 3 years of initial scan were calculated.ResultsOf 48 053 women who underwent ultrasound examination and had complete scan data, 4367 (9.1% (95% CI, 8.8–9.3%)) had abnormal adnexal morphology. Median follow‐up was 7.09 (25th–75th centiles, 6.03–7.92) years. Forty‐seven (32 borderline or Type I, 15 Type II) were diagnosed with EOC. The overall absolute risk of EOC associated with abnormal adnexal morphology was 1.08% (95% CI, 0.79–1.43%); for borderline and Type I it was 0.73% (95% CI, 0.5–1.03%); and for Type II it was 0.34% (95% CI, 0.33–0.79%). In the subgroup (n = 741) with solid elements (unilocular solid, multilocular solid and solid) overall absolute risk was 4.45% (95% CI, 3.08–6.20%), for borderline and Type I it was 3.1% (95% CI, 1.9–4.6%) and for Type II it was 1.3% (95% CI, 0.6–2.4%). 11 982 women had both ovaries visualized and normal annual scans throughout the 3‐year follow‐up period. In this group, no borderline or Type I and eight Type II cancers were diagnosed.ConclusionAsymptomatic postmenopausal women with ultrasound‐detected adnexal abnormalities with solid elements have a 1 in 22 risk for EOC. Despite the higher prevalence of Type II EOC, the risk of borderline or Type I cancer in women with ultrasound abnormalities seems to be higher than does the risk of Type II cancer. This has important immediate implications for patients with incidental adnexal findings as well as for any future ultrasound‐based screening. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.