Despite decades of research and two landmark randomized general population-based screening trials (PLCO and UKCTOCS), no population-wide ovarian cancer screening strategy has successfully reduced mortality. The biology of the disease - rapid tumor growth, peritoneal spread, and inaccessibility of precursor lesions - creates barriers that conventional blood tests or ultrasound cannot overcome.
In our new JAMA Oncology Viewpoint, we argue that it is time to change the narrative:
- Annual population screening is not the solution. Even promising new multi-cancer detection tests face fundamental challenges when applied to ovarian cancer.
- Targeted approaches hold promise. Intensified multimodal surveillance in high-risk groups (e.g. BRCA1/2 carriers) has shown earlier stage detection and less aggressive surgery.
- Primary prevention strategies such as hormonal modulation, antiprogestins, or prophylactic salpingectomy could substantially reduce risk - if deployed in the right women.
- Personalization is key. Most ovarian cancers occur outside known high-risk families. We propose investing in integrated risk-prediction tools combining genetics, epigenetics, clinical, and lifestyle data. Tools based on epigenetic signatures from cervicovaginal samples show particular promise for identifying women most likely to benefit from preventive interventions.
The way forward is precision prevention - moving beyond one-size-fits-all screening to risk-adapted strategies that can meaningfully reduce ovarian cancer incidence and mortality.
