For 16 years, a UK-wide collaboration of researchers, led by Prof Usha Menon and Ian Jacobs at UCL, followed over 200,000 women to see who developed ovarian cancer and at what stage it was caught to see whether a national screening programme for ovarian cancer could save lives.
The women were split into three groups: no screening, annual screening with a transvaginal ultrasound scan, and annual screening with a CA125 blood test followed by a transvaginal ultrasound if anything was picked up.
Currently, there is no national screening programme in the UK for ovarian cancer, and with the large majority of ovarian cancer cases diagnosed at a later stage and only 35% of women surviving for ten years or more- finding an effective screening programme is at the top of the research team, and The Eve Appeal’s agenda right from the beginning.
UKCTOCS (which stands for UK Collaborative Trial of Ovarian Cancer Screening), which was part funded by The Eve Appeal, was founded back in 1999, and the team hoped that one of the screening methods tried- ultrasound scans, or blood test plus an ultrasound- would prove effective at diagnosing ovarian cancer earlier, and importantly save lives.
The women were screened annually for eight years between 2001-2005 and 2011, then they were followed up until 2020 to see what happened to them.
Sadly, the results published today showed that neither screening method saved lives, compared to no screening, which is disappointing news. The trial did however find that annual screening of a blood test then ultrasound scan diagnosed patients earlier than those who had no annual screening. With ovarian cancer, earlier diagnosis is so important for quality of life, treatment options and survival time post diagnosis.
From UKCTOCS we now know that an annual blood test and ultrasound does pick up cancers at an earlier stage, with 39% of the ovarian cancers found being in stage 1 or 2, thats 10% more compared to having no screening. Unfortunately, it didn’t follow through to saving lives- which is the threshold needed to approve a screening programme on the NHS.
The research team have some theories as to why finding cancers earlier with annual blood test and scan screening didn’t result in lives being saved, Prof Usha Menon says: “We didn’t pick up enough women early and we didn’t pick up cancers early enough.” It was also noted that the women who were found to have ovarian cancer earlier, didn’t respond quite as well to the treatment as expected, which is something the team continue to investigate. “What we need to do now is to analyse very carefully what treatment people on the trial received. And there are a lot of insights that I think the trial can provide.” Treatments have also moved on significantly for advanced stage ovarian cancer since the trial was taking place, which could affect the results if the screening was taking place today.
The Eve Appeal and all of the researchers involved in this trial, including Prof Jacobs who led the trial, remain hopeful that one day we will find an effective method of screening for ovarian cancer, Prof Ian Jacobs says: “Population screening for ovarian cancer can only be supported if a test is shown to reduce deaths in a future randomised controlled trial. I remain hopeful that a new effective screening test will be found eventually, but it will take many years to conduct a large trial of the test”.
Although the trial didn’t reach a threshold for population national screening programme in the UK, we can’t underestimate the importance early diagnosis has to women and their families, Eve CEO, Athena says: “Shifting diagnosis one or two stages earlier makes a huge difference to both treatment options and quality of life. Earlier diagnosis will often reduce the amount and intensity of treatment, and this makes all the difference to women who are living with cancer. It may have also given them more precious time with their loved ones.”
It is important to get any worrying symptoms checked out- persistent bloating, feeling full quickly or difficulty eating, needing to wee more, persistent pelvic or abdominal pain or an unexplained change in bowel habits. If you have spotted any of these symptoms, do call your GP, you can also always Ask Eve for free and confidential information and advice on firstname.lastname@example.org or 0808 802 0019.
We want to thank all of the hundreds of thousands of women who took part in the study, without their support, UKCTOCS couldn’t have happened, and these important lessons wouldn’t have been learnt. The women who took part have also agreed for the samples to be kept for use in future research- with so many women involved, and so many samples, this is a hugely valuable tool for researchers across the globe. And a big thanks to our supporters, for allowing us to help fund this study- we are grateful for your continued support.
This study was co-funded by the NIHR (National Institute of Health Research), Cancer Research UK and The Eve Appeal.