Landmark Trials

Question 1

Effect of Screening on Ovarian Cancer Mortality

Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Answer 1

• JAMA, Buys et all
• randomised control trial of 78,216
• USA 1993 to 2001
• women 55 to 74yo
• intervention group (annual Ca125 and TV US) vs usual care
• results: ovarian Ca mortality 3.1 per 10,000 person years (intervention) vs 2.6 per 10,000 person years (control) RR 1.81 / ovarian Ca survival not statistically significant
• conclusion: routine screening vs usual care DID NOT reduce ovarian cancer mortality / diagnostic evaluation of false positive screening associated with complications
• criticism: borderline tumours not added to morbidity or mortality but added to complications risk / lack of observed stage shift (more stage III or IV) showing difficult to assess early / >15% loss to follow-up