The IX t h Makassed Medical Congress - American University of Beirut

SCREENING FOR GYNECOLOGIC CANCERS
Adnan R Munkarah, MD
The main goal of a cancer screening programs is early detection allowing more effective
therapeutic interventions and improved survival. With advances in medical technology and a
better understanding of tumor biology, guidelines for cancer screening have evolved over the
years for many malignancies.
Ovarian cancer is the sixth leading cause of cancer death in women in the United States.
Carcinomas arising from the surface ovarian epithelium represent the most common type of
ovarian cancer, are usually diagnosed in their advanced stages and carry a poor prognosis.
When detected at an early stage, the 5-year survival rate is 90%. The signs and symptoms
caused by ovarian cancer are frequently nonspecific. As a result, the majority of patients have
advanced stage disease at diagnosis. Efforts have focused on identifying screening modalities
for this disease. Ultrasound and blood Ca125 testing have been investigated in this setting
either as isolated or as combined screening modalities. The major concerns have been their
limited positive predictive value when used in screening women who have low to average risk.
Therefore there is an ongoing need to identify new screening tests and strategies which should be
readily available, well accepted by the population, cost effective and achieve high sensitivity,
specificity, positive and negative predictive values. Recently a US based company, Laboratory
Corporation of America, released OvaSure, a screening test that consists of a six-biomarker panel
including leptin, prolactin, osteopontin, insulin-like growth factor II, macrophage inhibiting factor
and Ca-125. The company claims that this new test discriminates between disease-free women
and ovarian cancer patients and has 95.3% sensitivity and 99.4% specificity. There have been a
number of statements by professional societies and recently a warning by the US Food and Drug
Administration raising concerns about the limited available data on this test and the inadequacy
in its validation.
An optimal screening test with high level of sensitivity and specificity is indispensable for early
detection of ovarian cancer. Serological screening with serum biomarkers (serum proteins and
autoantibodies) is being tested as a first-line screening test and this in combination with TVS or
color-flow Doppler imaging may prove very effective in early detection of ovarian cancer.
Cervical cancer is a major cause of cancer mortality around the world. Deaths related to
this disease account for 9% of all female cancer deaths claiming over 270,000 lives each year
worldwide (2). In addition, cervical cancer contributes over 2.7 million years of life lost among
women between the ages of 25 and 65; around 90% of these occur in develop countries (3). The risk
factors associated with cervical cancer were identified decades ago. However, a breakthrough
happened when the Human Papilloma Virus (HPV) was discovered and its association with cervix
cancer was confirmed in a number of studies. Currently, it is widely accepted that HPV infection
is the most important cause of cervix cancer.
In developed countries with an excellent public health infrastructure and a high compliance
of women, early cytological detection of cervical cancer (PAP smear) has led to an impressive
reduction of mortality while in other world regions, including Central America, South East Africa
and India, incidence and mortality rates are still very high. Today, more than 80 per cent of
all cervical cancer deaths occur in developing countries.This emphasizes the need to establish
national cervical cancer screening program in developing countries comparable to those in
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