E-poster Presentation 2014 World Cancer Congress

High rates of pelvic ultrasonography and tumor marker use suggest physician non-adherence to ovarian cancer screening guidelines (#1171)

Leigh J. Passman 1 , Adailton S. Batista 2 , Simon B. Sutcliffe 3 4
  1. Indicação Médica Consultoria Ltda, Rio de Janeiro, RJ, Brazil
  2. Human Resources, Petrobras S.A., Rio de Janeiro, RJ, Brazil
  3. Genome Sciences Center, British Columbia Cancer Agency, Vancouver, BC, Canada
  4. Cancer Control International, Inc, Vancouver, BC, Canada

Background: Indicators used to assess cancer prevention efforts include screening rates for breast, cervical and colon cancer in a population. Empiric data reveal actual screening practices diverge from guidelines.

Aim: Investigate whether physicians still screen for ovarian cancer employing pelvic ultrasonography and the CA-125 tumor marker despite the absence of guidelines endorsing ovarian cancer screening in average risk women and several (USPSFT, ACOG) that explicitly recommend against screening.

Methods: Data source: Health plan utilization database, 2009-2012. Tests performed and the percentage of beneficiaries tested were determined. Billing data did not permit us to distinguish tests ordered for screening from those ordered for investigation of symptoms or to accompany patients already diagnosed. A single billing code used for four different tumor markers complicated the analysis.*

Results: Among 62,531 women age 30-59, 57.7% underwent non-obstetrical pelvic ultrasonography at least once in 24 months (Jan 2011-Dec 2012). Among 17,714 women age 40-49, the rate was 63.1%. Among 17,884 women age 60-69, the rate was 47.5%.

Among 74,324 women age 40-79, the number and percentages who had the tumor marker tests done at least once:
                                                                                          # of women          % of women
CA-125                                                                                       1339                      1.8 %
*CA-125/CA-19.9/CA-15.3, or CA-72.4                                   7204                      9.7 %
Carcinoembryonic antigen (CEA)                                              5201                      7.0 %

Conclusions:  Testing rates found are so high, certainly most pelvic US and CA-125 testing constitutes inappropriate screening of asymptomatic normal risk individuals.  False positive results (not quantified) expose beneficiaries to further diagnostic investigation and associated morbidity. Physicians are ordering pelvic ultrasound and CA-125 as if an affirmative rather than a negative recommendation to screen for ovarian cancer existed. This empiric data suggests ordering physicians, especially gynecologists, are ignorant of or consciously ignore guidelines that discourage ovarian cancer screening. Expenses incurred by health plans for tests that contravene guidelines constitute a logical target for re-allocation to beneficial services.

  1. U.S. Preventive Services Task Force (USPSTF) Recommendations http://www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarcancerrs.htm