Data from a large NIH-sponsored study has shown that annual screening for ovarian cancer fails to detect early-stage disease and generates frequent, unnecessary surgeries to boot.

In a study conducted by Edward Partridge and colleagues at the University of Alabama at Birmingham, more than 70% of cancers detected by transvaginal ultrasound and CA 125 biomarker testing were stage III or IV at the time of diagnosis.

That’s about what happens when women aren’t screened at all.

“These data suggest we need a better screening tool,” Partridge said in a statement picked up by MedPageToday. “We need a test that is more sensitive and more specific so we find the cancer earlier and we catch the biological markers that give us stronger clues.”

The write-up is in Obstetrics & Gynecology.

The scientists enrolled 34,261 healthy women with intact ovaries who were between the ages of 55 and 74.

Compliance with both screening tests was 83% at baseline and stayed high at 78% through the fourth round.

In Year 1 of the program, positive test results obligated 566 surgical procedures which uncovered only 18 cancers, more than 80% of which were stage III or IV.

In the subsequent 3 years, 604 surgeries followed a positive test result, and 42 invasive cancers were found. Here again, most of the malignancies were stage III or higher.

On the false-negative side of things, overall, 89 cases of ovarian cancer were diagnosed during the study, and a third of them had been missed altogether by both screening modalities.

The study’s primary endpoint, which is impact of annual screening on ovarian cancer mortality, has yet to be determined. Bet the house on no impact.

Last fall, the Milbank Memorial Fund authored a white paper on the status of maternity care in the US.

The report concluded that excessive reliance on high tech gadgetry, monitoring and testing made our country by far the most expensive place on Earth to have a baby, yet we graded out average among developed nations when it came to neonatal and maternal mortality.

Last week NIH investigators reported in Obstetrics & Gynecology that if anything, things are getting worse.
 
Elena Kuklina and colleagues of the National Institute of Child Health and Human Development performed a cross-sectional study of 32 million discharge records from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.

They found that the rate of severe delivery-related complications increased 26% between 1998-1999 and 2004-2005; from 64% per 1,000 deliveries to 0.81%.

Meanwhile, Caesarean deliveries as a fraction of all deliveries rose during the period from 21.2% to 31.1%.

Roughly 2,760 women died from delivery-related complications during the study period, while 227,333 experienced one or more severe complications.

“During the study period, there was a greater than 20% increase in rates of renal failure, respiratory distress syndrome, shock, and ventilation, a 52% increase in rates of pulmonary embolism, and a 92% increase in rates of blood transfusion,” wrote the authors.

The findings could not be explained by differences in maternal age, multiple births (including Octomoms), pre-existing conditions or insurance status.

Increased utilization of C-sections “seemed to explain the observed change over time for renal failure, respiratory distress syndrome, and ventilation,” they wrote.

But that explained only half the rise in blood transfusions, shock and pulmonary embolism, according to the authors. As for the rest of it, who knows?