Deliberating screening for gynaecological cancer

Screening for cervical cancer remains more critical than that for endometrial and ovarian cancers, says a specialist. 

Unlike in endometrial cancer, screening for cervical cancer is important as it tends to be painless and the patients are diagnosed only in the later stages. As for ovarian cancer, the role of screening is debatable.

The evidence available currently does not support the recommendation for ovarian cancer screening, said consultant obstetrician and gynaecologist, Dr. Paul Ng. Quoting the findings of the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial, he said only 40 percent of the participants were diagnosed with ovarian cancer by the end of the screening.

Having said that, a study showed the majority of gynaecologists still believe in screening for ovarian cancer. One of the tests that can be used to screen for ovarian cancer is checking for the serum marker cancer antigen (CA)-125. Healthy men and women have CA-125 levels less than 35 iu/ml, and post-menopausal women have levels less than 20 iu/ml, explained Ng. By using a cut-off CA-125 value of 30 iu/ml, the screening test will have a specificity of 97 percent and positive predictive value (PPV) of merely 4.6 percent. If a transvaginal scan is carried out at the same time, the specificity will become nearly 100 percent and the PPV 26.8 percent, he said.

Screening for cervical cancer has been shown to reduce the incidence of cervical cancer and deaths due to the disease, said Ng. Even if a patient had received the human papilloma virus (HPV) vaccine, she should still undergo cervical cancer screening.

Patients with endometrial cancer are usually diagnosed in the early stages because the symptoms present early. At the moment, there is no regular endometrial cancer screening test for women in the general population. Nevertheless, in high risk groups, endometrial cancer screening is required. An example of such a group is patients taking tamoxifen, an anti-oestrogen. They were found to have a 6.4 fold increase in risk of endometrial cancer, he said. Healthcare providers should take note of symptoms like vague abdominal discomfort, postmenopausal bleeding and abdominal bloating. If endometrial cancer is suspected, a transvaginal ultrasound and endometrial sampling with cytological examination may be done.

To help win the fight against gynaecological cancers, healthcare providers should advocate regular cervical screening, advise patients to undergo human papilloma virus (HPV) vaccination and prescribe contraceptive pills whenever appropriate, said Ng. Also, doctors should not be overly cautious when it comes to performing ultrasound scans and conduct mammogram, bone densitometry and cardiac risk assessments whenever possible.