Bias in Ovarian Cancer Screening Increases Risk of Patient Harm

Despite recommendations against screening low-risk patients for ovarian cancer, personal experiences with cancer can prompt physicians to act outside the guidelines.

Physicians who have had personal experiences with cancer have a higher likelihood than their peers of ordering ovarian cancer screening against established recommendations, new research says.

Unrecommended screening exposes patients to risks of harm associated with testing procedures as well as surgery following a false positive test, according to the research, which was published this month in the Journal of Women's Health.

The lead author of the research, Margaret Ragland, MD, MS, of the University of Colorado Hospital in Aurora, says physicians who have had cancer themselves or in their social circles are biased toward ordering too many preventative cancer services.

"My hypothesis is that a doctor's personal experience may influence their assessment of risk. You see a patient in front of you and you may assess the risk to be higher than it actually is," she said in a prepared statement.

Ordering ovarian cancer screening outside established guidelines is problematic, according to the U.S. Preventative Services Task Force:

• USPSTF has given routine ovarian cancer screening a "D" grade—a designation for medical services deemed ineffective or unlikely to generate benefits that outweigh potential harms.
   
• The tests for ovarian cancer—transvaginal ultrasound and cancer antigen 125—have low positive predictive value and high false positive rates.
   
• There is scant evidence that screening improves morbidity or mortality.

Screening for ovarian cancer is not recommended for women at low risk or the general population of women.

Earlier research found significant risks of patient harm associated with ovarian cancer screening such as bleeding, fainting, nausea, and bruising. This research also found that 5% of women screened for ovarian cancer experienced false positive tests, which resulted in unnecessary major surgery for many patients.

Other earlier research questioned the cost of ovarian cancer screening because the low prevalence of ovarian cancer in the general population of women limits the cost-effectiveness of routine testing.

Bias found
 

The Journal of Women's Health research features survey data collected from 504 physicians. The survey included a vignette of a woman at average risk of ovarian cancer.

In an unadjusted analysis, 86.0% of physicians who lacked personal experience with cancer reported following ovarian cancer screening guidelines. Among physicians who had personal experience with cancer, 69.2% reported following the screening guidelines.

After adjusting the data for factors including patient age, race,

insurance status, and requests for ovarian cancer screening, physicians who had personal experience with cancer were 0.82 times more likely to order testing outside recommended guidelines.

Raising awareness of the potential for bias in ovarian cancer screening is the primary recommendation of the Journal of Women's Health researchers.

"Results from this study can increase physician awareness of and improve training about factors that may unintentionally influence their clinical practices," the researchers wrote.