Reported Ovarian Cancer Screening Among a Population-Based Sample in Washington State CHARLES DRESCHER, MD, SARAH K. HOLT, MPH, M. ROBYN ANDERSEN, PhD, GARNET ANDERSON, PhD, AND NICOLE URBAN, ScD Objective: To assess the prevalence of reported ovarian cancer screening among a population-based sample of women from Washington state and identify factors that influence the decision to be screened. Methods: A population-based sample of 6749 women aged 54 – 84 years, living in 40 predominately rural communities in Washington state, was surveyed about their utilization of ultrasonography and CA 125 for ovarian cancer screening. We also assessed relevant demographic, family history, psychosocial, and health behavior variables. Results: After exclusions, data from 4938 respondents were available. Two percent (n  96) reported having been screened. Multiple logistic regression identified ovarian cancer worry, contact with an obstetrician-gynecologist, and family history of ovarian cancer as independently associated with screening. Based on self-reported family histories, 27 women had pedigrees consistent with high risk of ovarian cancer, but none of those women reported having been screened. Conclusion: Ovarian cancer screening is rare. Women at high risk of it might not be getting recommended screening. (Obstet Gynecol 2000;96:70 – 4. © 2000 by The American College of Obstetricians and Gynecologists.) The value of early detection screening for ovarian cancer using the serum tumor marker CA 125 or trans- vaginal sonography is uncertain. Transvaginal sonog- raphy has reported sensitivity as high as 100% but resulted in 10 –20 operations for each malignancy de- tected. 1,2 CA 125 level elevated to at least 35 U/mL is approximately 50% sensitive and 98% specific for early- stage disease. 3–5 False-positive screens can cause unnec- essary anxiety, surgery, and morbidity. Evidence that screening reduces mortality rate is lacking, although there are at least two current randomized controlled trials. 6,7 In 1994, a National Institutes of Health (NIH) consen- sus conference on ovarian cancer published screening recommendations. 8 Routine screening of women with- out a family history of ovarian cancer was not recom- mended, although they are candidates for enrollment in screening trials. Screening outside a trial is appropriate for women with at least one first-degree relative with ovarian cancer if they are informed of risks of screening and the lack of prospective data showing benefit. Screening that included at least annual rectovaginal pelvic examinations, CA 125, and transvaginal sonog- raphy is recommended for women with family histories consistent with hereditary ovarian cancer syndrome. How closely clinical practitioners adhered to those guidelines is not known. We surveyed a population-based sample of women from Washington state about ovarian cancer screening. Our objective was to determine contemporary medical practice with respect to ovarian cancer screening and provide information for designing efficient screening programs, should it prove beneficial. Methods Data were collected by telephone interviews completed in 1998 as part of a follow-up survey of participants in the Community Trial for Mammography Promotion, which was a randomized community trial to examine the effectiveness of mammography promotion strate- gies. 9 Women who participated in it were identified from a commercial mailing list of 44,503 women who represented all identifiable 50 – 80-year-olds in 1994, who lived in 40 predominately rural counties in Wash- ington state. Equal numbers of women from each community were selected randomly for baseline inclu- sion. Follow-up interviews, on which our study was based, From the Department of Obstetrics/Gynecology, University of Wash- ington, Seattle, Washington; the Marsha Rivkin Center for Ovarian Cancer Research, Seattle, Washington; and the Fred Hutchinson Cancer Research Center, Seattle, Washington. Financial support for this paper was provided by Community Trial of Mammography Promotion, Grant CA60131 from the National Cancer Institute. 70 0029-7844/00/$20.00 Obstetrics & Gynecology PII S0029-7844(00)00849-8