SCREENING FOR EARLY FAMILIAL OVARIAN-CANCER WITH TRANSVAGINAL ULTRASONOGRAPHY AND COLOR BLOOD-FLOW IMAGING

Objective-To assess the value of transvaginal ultrasonography with colour blood flow imaging in detecting early ovarian cancer in women with a family history of the disease. Design-Study of self referred symptomless women with a close relative who had developed the disease. Each woman was screened to detect persistent lesions and defined changes in ovarian volume. Morphological score and pulsatility index were recorded. Setting-Ovarian screening clinic. Subjects-1601 self referred women. Interventions-Women with a positive screening result were recommended to have further investigations. Main outcome measures-Findings at surgery and histology of abnormal ovaries. Morphological score greater-than-or-equal-to 5 and pulsatility index < 1.0 at last scan. Results-Women were aged 17 to 79 (mean 47) years; 959 (60%) were premenopausal, 469 (29%) were naturally postmenopausal, and 173 (11%) had had a hysterectomy. 157 women had a pedigree suggestive of the site specific ovarian cancer syndrome and 288 of multiple site cancers. 61 women had a positive screening result (3.8%, 95% confidence interval 2.9 to 4.9%), six of whom had primary ovarian cancer detected at surgery (five stage Ia, one stage III). Use of a high morphological score or a low pulsatility index increased the odds of finding ovarian cancer from 1:9 to about 2:5 (1:1 in the highest risk groups). Five interval cancers were reported (three ovarian and two peritoneal). Eight of the 11 cancers developed in women with pedigrees suggestive of inherited cancer. Conclusions-Transvaginal ultrasonography with colour flow imaging can effectively detect early ovarian cancer in women with a family history of the disease. The screening interval should be less than two years.