Efficacy of an optimal ovarian cancer screening: a best-case scenario study based on real-world data

• Published in: Archives of gynecology and obstetrics 2022-01, Vol.305 (1), p.159-167
• Main Authors: Steinkasserer, Lena, Irmgard, Delmarko, Weiss, Tatjana, Dirschlmayer, Walter, Mossig, Michael, Zeimet, Alain G., Marth, Christian
• Format: Article
• Language: English
• Subjects: Asymptomatic; Austria - epidemiology; Carcinoma, Ovarian Epithelial - pathology; Early Detection of Cancer; Endocrinology; Female; Gynecologic Oncology; Gynecology; Histology; Hospitals; Human Genetics; Humans; Medical screening; Medicine; Medicine & Public Health; Mortality; Neoplasm Staging; Obstetrics; Obstetrics/Perinatology/Midwifery; Ovarian cancer; Ovarian Neoplasms - pathology; Womens health
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-021-06117-4

Purpose To date, ovarian cancer screening in asymptomatic women has not shown a mortality benefit. The aim of this simulation study was to outline the impact of different histological subtypes on a potential stage-shift, achieved by screening. Methods Real-world data were derived in the period of 2000–2017 from the Klinischen Tumorregister Austria. We estimated five-year overall survival (OS) of patients with ovarian cancer regarding different histological subtypes and FIGO stages. A theoretical model was generated predicting the trend of OS mediated by an eventual down-shifting of ovarian cancer from FIGO stage III/IV to FIGO stage I/II by screening, considering the influence of different histological subtypes. Results 3458 ovarian cancer patients were subdivided according to histological subtypes and FIGO classification. Major difference in distribution of histological types was found between FIGO stage I/II and III/IV. A theoretical down-shift of tumors from high to low FIGO stages based on our registry calculations showed that the five-year OS would increase from 50% to nearly 80% by perfect screening. Conclusion In our simulation study, we showed that down-shifting ovarian cancers by successful screening might increase OS by 30 percentage point. Our results underscore the importance to recognize ovarian cancer as a heterogenous disease with distinct epidemiologic, molecular and clinical features. The individual characteristic of each histotype is of utmost impact on the definition of screening aims and may influence early detection and stage-shift. Efficacy of screening is mainly dependent on detection of high-risk cancer types and not the slow growing low-grade types.