09:26pm Wednesday 27 May 2020

Research offers hope for early detection of ovarian cancer

Preliminary results from UKCTOCS show that in the first screen of the 100,000 women participating in the screening arms of the trial, screening detected ovarian cancer or borderline tumours in 87 women and missed picking up 13 women who went on to develop the disease within a year of screening. Almost half (48%) of the 58 cancers detected were at an early stage. The Lancet Oncology paper does not report on cancers in the 100,000 women included in the control arm of the trial who are not being screened; this is in accordance with current NHS guidelines as there is no ovarian cancer screening programme. Cancers that developed in women in the screening arms in the subsequent years of the study are not reported in this first analysis.

Speaking about the early results, lead investigator Professor Ian Jacobs, director of the UCL (University College London) Institute for Women’s Health, stressed:

‘‘There is a long way to go before we have firm evidence as to whether or not screening is able to detect cancer early enough to save lives. It will also be essential to balance any benefits offered by screening with the downside, as it is recognised that screening can cause anxiety and lead to some unnecessary operations.’’

‘‘The UKCTOCS trial is the largest trial of its kind ever run to investigate ovarian cancer and we are enormously grateful to the women who have taken part. It will conclude in just over 5 years and if the findings are positive my hope is that what we learn will pave the way for a national ovarian cancer screening programme.”


Ovarian cancer is most common in women who have gone through menopause and diagnosis is usually when cancer is already in the advanced stages. Women from 27 Primary Care Trusts in England, Wales and Northern Ireland were asked to join the study. All of the 200,000 women recruited to the trial between 2001 and 2005 through the 13 participating NHS Trusts were postmenopausal and aged between 50 and 74 years old. Following the initial screen, reported in this Lancet paper, women are continuing to be invited for further screening until 2011. Everyone will be followed up until December 2014.


Two screening methods are being used in the UKCTOCS trial: a blood test or an ultrasound scan. The blood test measures levels of a protein called CA125 that is often elevated in the blood of women who have ovarian cancer. The research team used statistics to determine risk of ovarian cancer based on the woman’s age, how much CA125 was present and how the level changed with time. The ultrasound scan is used to look for abnormalities in the ovaries. Approximately 50,000 women were allocated to screening using the blood test and a further 50,000 to ultrasound to measure the efficacy of these screening methods.


If a volunteer’s blood test result suggested risk of ovarian cancer, the woman was recalled for additional screening and follow up; 97 had surgery to remove the ovaries and 42 women with ovarian cancer were identified in this group.


Women in the ultrasound group who were found to have persistent abnormalities were referred for a specialist opinion; 845 had surgery to remove the ovaries and 45 women with ovarian cancer were identified in this group. The research team found both methods of screening were encouragingly sensitive. Almost half the cancers detected were at an early stage (I or II).


The research team suggest that the higher number of repeat tests and surgical procedures in the ultrasound group could be attributed to the number of older women who have benign ovarian cysts which are detected by ultrasound. A proportion of these women have to undergo surgery and examination of the ovarian tissue before diagnosis of ovarian cancer can be ruled out.


The study is being run from the Gynaecological Cancer Research Centre, UCL Institute for Women’s Health. As the trial progresses, researchers will continue to monitor how many of the 202, 638 women develop ovarian cancer. In the 101,000 undergoing screening the team will monitor how many of cases of cancers are detected and at what stage. They will also record how many women have surgery.


Dr Usha Menon, UKCTOCS trial co-ordinator and one of the principal investigators said:

“These results are extremely encouraging. We’d like to thank all of the women involved in the trial and to encourage them to continue helping us by attending for screening until the end of the trial. The early results suggest that both types of screening can be used on a large scale and both successfully identify ovarian cancers. However, we must wait till 2015 before we can conclude whether or not a wider screening programme could lead to a fall in deaths due to ovarian cancer.”

The UKCTOCS trial has been funded by the Medical Research Council, Cancer Research UK and the National Institute for Health Research and is supported by gynecological cancer research charity The Eve Appeal.


Professor Ian Jacobs concluded:

“I believe the UKCTOCS trial is an example of UK healthcare at its best. It is a combination of a huge research effort, involving charity, research council and Government funders, hospital staff, university researchers and GPs around the UK and crucially more than 200,000 women. The first results are an important step forward and the trial itself is a powerful demonstration of how our best scientists, clinical researchers and healthcare workers in the UK collaborate in research and involve volunteers nationwide to improve health.’’


Original research paper: Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is published in Lancet Oncology.

UKCTOCS trial website

March is ovarian cancer awareness month

You can find more information about ovarian cancer on the Cancer Research UK Cancer Help website, on the Eve Appeal website or National Institute for Health Research.

Ovarian cancer is the fourth most common cause of cancer death in UK women with nearly 7,000 women diagnosed annually and 4,500 women dying every year from the disease. Women diagnosed in the later stages (stage III or IV) of ovarian cancer have a survival rate of 30 per cent, compared to 80-90 per cent of those diagnosed in stages I/II. The hope is that screening to diagnose ovarian cancer at an earlier stage can improve these poor survival rates.

Early detection of ovarian cancer 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. The Department of Health has recently issued two sets of guidance on signs and symptoms of ovarian cancer – one for members of the public (October 2008) and the other for health professionals (February 2009).


UKCTOCS Regional Centres



Co-ordinating Centre

Gynaecological Cancer Research Centre,

Institute for Women’s Health,

University College London


Regional Centres

Start date



Queen Elizabeth Hospital




Mr Keith Godfrey (previously Mr Tito Lopez)

St Bartholomew’s Hospital

London – St Bart’s



Ms Usha Menon & Mr David Oram

Liverpool Women’s Hospital




Mr Jonathan Herod

Nottingham City Hospital




Ms Karin Williamson

St Mary’s Hospital




Mr Robert Woolas

The Royal Free Hospital

London – Royal Free



Mr Tim Mould

St Michael’s Hospital




Mr John Murdoch

Belfast City Hospital




Mr Stephen Dobbs

Cardiff University




Mr Nazar Amso

Llandudno General Hospital

N. Wales – Llandudno



Mr Simon Leeson

St Mary’s Hospital




Mr Mourad Seif

Derby City Hospital




Mr Howard Jenkins (previously Mr Ian Scott)

The James Cook University




Mr Derek Cruikshank







Other studies being undertaken in UKCTOCS

Innovative approaches were used in UKCTOCS to recruit more than 200,000 women as reported in a paper published in the BMJ. (Menon,U. et al. Recruitment to multicentre trials–lessons from UKCTOCS: descriptive study. BMJ 2008, vol 337, pp1283-6).


Women participating in UKCTOCS have been very generous and given permission for their data and samples to be used in other secondary research studies. Several of these are underway and some have reported, including

  • Trends in HRT use among the women who joined UKCTOCS showed that there was a steady decline in use throughout the recruitment period. This is thought to be due to the premature closure of HRT trials and the ensuing publicity. The study was published in the journal Menopause in 2007 (U. Menon et al for the UKCTOCS group. Decline in use of hormone therapy among postmenopausal women in the United Kingdom. Menopause volume 14: pp462-67).
  • Managing menopausal symptoms (MMS) is a survey asking UKCTOCS women in depth how they manage their menopause, whether they are using any non-HRT treatments to cope with the symptoms and their attitudes to these treatments. Questionnaires were sent to 11,000 women who volunteered to participate in this and analysis is underway to assess level of use, and potential benefit, of over-the-counter remedies such as black cohosh or dietary and lifestyle changes. This is a little studied area as it falls outside standard clinical practice.
  • A valuable component of the trial is that the serum bank contains samples from volunteers that will precede a diagnosis of cancer. Collaborative projects with other research groups are underway using serum samples collected from UKCTOCS volunteers to try to find better predictive markers initially in ovarian, breast and pancreatic cancers. It is hoped that the bank will help in the development/ validation of blood tests for new protein markers that can detect cancers earlier.
  • A similar study is also underway exploring the role of both epigenetic and hormonal changes in serum for the prediction and early detection of breast cancer. Epigenetics is the study of heritable changes in gene function that occur without a change in the DNA sequence.
  • The role of USS measurement of the thickness of the lining of the womb in early detection of endometrial cancer is being analysed using data collected in women in the USS group.
  • A PhD project is underway in the USS group to determine whether the presence of tiny ovarian inclusion cysts which occur in around 2% of healthy postmenopausal women is associated with any increased risk of developing breast, ovarian or endometrial cancer.
  • It has become clear that the number of deaths from common diseases including cancer is lower in the UKCTOCS volunteers than we would expect from UK population statistics. We believe this is because people who volunteer to take part in trials like UKCTOCS tend to be better informed about health issues and are less likely to have unhealthy habits, such as smoking. We are clarifying this ‘healthy volunteer effect’ and will report our findings as they have significant impact on the design of future clinical trials.
  • A prospective survey of symptoms in 100,000 women participating in UKCTOCS is underway. Follow up will help assess if symptoms can help us diagnose ovarian cancer earlier in women


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