DECIDING ABOUT SCREENING

As shown in an accompanying article, the benefits of any broadly based screening program for ovarian cancer are limited more by the low prevalence of disease than by the potential benefits of treating early disease or the performance of currently available tests. Screening for such diseases is best restricted to special populations at markedly increased risk. In low-prevalence populations, false-positive results and the costs and risks of the workups they induce are magnified. In determining the marginal cost-effectiveness ratio of such programs, failure to consider even apparently minor factors can markedly affect the conclusions. In the case of screening for ovarian cancer, factoring in the discomfort and potential inconvenience of venipuncture and transvaginal sonography can eliminate the small benefit of the program. Taking the time and energy required to organize relevant data in constructing a decision analytic model can provide important insights into the usefulness of such screening programs.