Blow to ovarian screening hopes

Screening did not detect cancerous cells

Almost 40,000 US women were checked annually over a 10-year period, the Journal of the American Medical Association reported.

During the following nine years, the number of ovarian cancer deaths matched those in an untested group of the same size.

Cancer Research UK said it was seeking new methods to detect the cancer.

While ovarian cancer is not the most common in the UK, it causes more than 4,000 deaths a year.

This is because it is often far advanced by the time that symptoms become obvious.

If caught early, up to nine out of 10 women can survive.

Two types of test are at the centre of hopes for a successful screening programme - a blood test looking for a high levels of a chemical associated with the cancer, and an ultrasound test which looks directly for abnormalities.

Unsuccessful

The University of Utah study, which started in 1993, used both tests in combination, with women given the blood test once a year for the first six years, then annual ultrasound examinations for the remaining four years.

Continue reading the main storyOvarian Cancer Fourth most common cause of cancer death in UK Nearly 7,000 diagnoses and nearly 4,500 deaths a year Survival rate when diagnosed in early stages: up to 90% Survival rate when diagnosed in later stages: 30% Early detection is complex as signs and symptoms of ovarian cancer are easily mistaken for other, more common and less serious conditions The average GP only sees one case of ovarian cancer every five years By the time the study closed in 2010, slightly more cases of ovarian cancer had been diagnosed in the screened group, compared with the group offered no screening.

However, there were 118 deaths among the screened women, and 100 in the unscreened women, which amounted to no real difference in statistical terms.

In addition, the screening programme threw up 3,285 "false positive" results, in which the tests suggested cancer might be present, even though this was not the case.

Of these women, more than 1,000 underwent unnecessary surgery, many opting for surgical removal of one or both of their ovaries. These operations led to 222 cases of "major complications".

The researchers suggested that using a different combination of blood tests and ultrasound might improve the outcome.

However, they said that the fast-growing nature of many ovarian cancers could mean that even annual tests might not offer enough women the chance to catch it at an early stage.

A similar UK-based trial is still some years away from giving its verdict on the effectiveness of ovarian screening.

The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) delivered encouraging results at its halfway point in 2009, with both types of test proving accurate in detecting cancers.

Like the Utah researchers, British teams are now waiting until the middle of this decade to see if this has any positive effect on overall deaths from the disease.

Dr James Brenton, an ovarian cancer specialist at Cancer Research UK, said that the charity was funding research into different methods of spotting tumours in their early stages.

He said: "This important research suggests that having a yearly ultrasound test along with a blood test, which provides a snapshot of the levels of protein associated with ovarian cancer - the serum CA125 test - is not going to cure more women.

"We are testing whether smaller rises in CA125 over time can be a better predictor, and working with international groups to identify common genes that might slightly increase the risk."

More screening in pregnancy urged

Experts are divided on the need for thyroid screening Thyroid 'risk from pre-eclampsia' All pregnant women should be screened for hidden signs of thyroid disease, according to Czech researchers.

A blood test can pick up about a third of mothers-to-be who have no symptoms but will go on to develop full-blown disease after giving birth, they say.

Early detection could have major implications for the health of mothers and babies, they told the European Congress of Endocrinology.

UK midwives say more evidence is needed of the merits of screening.

The study, led by Dr Eliska Potlukova of Charles University in Prague, followed almost 200 women through early pregnancy and beyond.

About half of these had no symptoms of thyroid problems but had tested positive for a marker in the blood that suggests they may be at future risk.

Continue reading the main storyThyroid disease in pregnancy Thyroid disease happens when the thyroid gland produces too much (hyper) or too little (hypo) thyroid hormone Common causes of hyperthyroidism include Graves' Disease - where the body's immune system turns on itself Another auto-immune disorder - Hashimoto's thyroiditis - which causes hypothyroidism - is also common in pregnancy Uncontrolled thyroid conditions can cause risks to the mother and baby About a third of these women went on to develop thyroid problems within two years of birth.

Dr Potlukova said tens of thousands of European women who will have thyroid problems could be detected earlier, which has major implications for the health of mother and baby.

She told the BBC: "If a woman of childbearing age is thinking of getting pregnant she should visit her GP or gynaecologist to have her blood tested for thyroid function and thyroid auto-immunity.

"Every young women should be sure that her thyroid gland works fine before she gets pregnant."

Screening all pregnant women for thyroid problems has been discussed in many countries.

'Right direction'

In the US, universal screening was rejected in 2006 on the grounds of a lack of evidence that it would improve outcomes for mothers and babies.

Most countries, including the UK, recommend screening only high-risk women who have a family history of thyroid disease or have suffered thyroid problems in the past.

Sue Jacobs, a midwife teacher at the Royal College of Midwives, said more evidence was needed for the benefits of universal screening.

She said: "In the UK we have a comprehensive programme of antenatal care from as early as possible in pregnancy.

"This gives us a good baseline to monitor women throughout pregnancy and immediately after pregnancy."

The research was "a step in the right direction", she added, but needed to be repeated on a larger scale.