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Few of us remember, but in the relatively recent past uterine cervical cancer was one of the most lethal of malignancies. It still is in many countries. The advent of the Papanicolaou smear, and the ensuing shift towards mass screening and early detection, has resulted in 2006 U.S. statistics that are frankly stunning by comparison: only 9700 cases, with 3700 patients dying of the disease.¹ In this issue of the journal, Doctors Reynolds and Moller discuss the current state of screening for today’s most lethal gynecologic malignancy: ovarian cancer. While we can claim screening successes in cervical and prostate cancer, we have been frankly unsuccessful in ovarian cancer. In truth, we might have been spoiled by successes with the Papanicolaou smear, or with PSA; by comparison, the positive predictive value of CA-125 is extremely low. Adapted methods using either additional testing (for instance, ultrasound) with CA-125, or targeted to high-risk populations, are being investigated in attempts to increase yield of the screen.

The authors have neatly compiled current thought and data on this area of critical importance. Given our current suboptimal therapies for advanced ovarian cancer, defining better treatment regimens should proceed in concert with defining better screening and early detection mechanisms. Only by this dual-pronged approach may we ultimately reprise our uterine cervical cancer success with cancer of the ovary.

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References 

1. American Cancer Society. Cancer Facts & Figures 2006. Available from: http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf . Accessed August 3 2006.
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