Ovrian Cancer Screening in Kentucky

Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. This year, over 23,000 new cases of ovarian cancer will be detected and over 13,000 women will die of disease. The lifetime risk of ovarian cancer in American women is 1 in 70 (1.4 per cent) but may be as high as 30 per cent in certain families. Since early ovarian cancer produces few specific symptoms, most women present with advanced stage disease where the prognosis is poor. The University of Kentucky Ovarian Cancer Screening Program was initiated in 1987 in an attempt to detect ovarian cancer at an early stage when it is curable. Since that time, this program has provided free transvaginal sonography (TVS) screens to over 16,000 Kentucky women. This technology produces an accurate picture of each ovary and is able to detect even small ovarian tumors. All women over the age of 50, and women over the age of 25 with a family history of ovarian cancer, are eligible to participate in this screening program. To date, over 200 ovarian tumors and 20 ovarian cancers have been detected by screening. Seventeen of these patients have had early stage disease and have been cured. The survival rate of women whose ovarian cancers were detected by screening is 88 per cent, or about twice that of ovarian cancer patients who did not have screening. At the present time, there are three full-time sonographers at the University of Kentucky Medical Center providing free screening to approximately 6000 women per year. Patients from every county in Kentucky participate in the Ovarian Cancer Screening Program. With the present capacity for screening, there are many more women who wish to be screened than we can accommodate. As a result, there is a 2-3 month waiting period for those who have enrolled in the study to be screened. In the present request to expand the Ovarian Cancer Screening Program, we are proposing to add four more sonographers and to provide monthly screening days at four (4) off-site locations in Floyd, Hardin, Mason, and Pulaski counties. On these days, free screening will be provided. In addition, other educational materials concerning ovarian cancer will be provided. With the additional sonographers, we hope increase the number of patients screened to at least 10,000/year. This will shorten the waiting period and increase the efficiency of screening. We now have information on 60,000 women/years of screening, and our goal for this project is to reach 150,000 women screening years. This number of women screening years will allow adequate statistical evaluation of the effect that annual sonographic screening has on ovarian cancer mortality in Kentucky. At present rates of screening, an additional 5 years will be required to reach this goal. At that time, we should be able to show conclusively that annual sonographic screening causes a statistically significant reduction in ovarian cancer mortality. The data will then be made available to insurance providers with the hope that screening for high risk groups will be reimbursable. This should result in increased demands for fully-trained screening personnel to provide screening at regional medical centers throughout the state. We are including an educational component in the budget to provide training in various aspects of ovarian cancer screening to ultrasound technical students and physicians in order to meet the future demand for screening personnel in Kentucky.