Evidence map›Paper›PMID 33991479›Full record

Trial reportLancet (London, England)2021

Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial.

Usha Menon, Aleksandra Gentry-Maharaj, Matthew Burnell, Naveena Singh, Andy Ryan, Chloe Karpinskyj, Giulia Carlino, Julie Taylor, Susan K Massingham, Maria Raikou and 19 more

2 registry-linked trialsOpen access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 421 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
421citing papers in PubMed, 7 pooled it
93.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00058032 nacompletednot on this map

United Kingdom Collaborative Trial Of Ovarian Cancer Screening

TypeinterventionalSponsorUniversity College, LondonRan2001 to 2020Enrolled202,638ConditionsOvarian CancerArmsscreening questionnaire administration, annual screening
NCT05721326 nacompletednot on this mapstarted 2023, after this paper: background citation

Sequential EHR Based Interventions to Increase Genetic Testing for Breast and Ovarian Cancer Predisposition Across Diverse Patient Populations in Gynecology Practices at Penn Medicine

TypeinterventionalSponsorAbramson Cancer Center at Penn MedicineRan2023 to 2025Enrolled1,283ConditionsGenetic Predisposition to Disease, Breast Cancer Female, Ovarian Cancer, Hereditary Breast and Ovarian CancerArmsSequential EHR Communications
3 · Its place in the literature

Who cites it

421 citing papers in PubMed, 7 syntheses or guidelines pooled it, 662 citations in OpenAlex.

  1. Pooled it
  2. Late-Stage Outcomes as Surrogates for Mortality in Cancer Screening Trials: A Systematic Review and Meta-analysis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025
    Pooled it
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  8. Combination of transvaginal ultrasound with cervical cancer screening contributes to early detection of ovarian cancer: Clinical trial.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Trial
  9. Estimating the Opportunity for Early Detection of Ovarian Cancer Using Individual-Patient Data from a Large Randomized Controlled Trial.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025
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  13. Article
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  15. Using Polygenic Risk Scores to Refine Risk and Outcomes in High-grade Serous Ovarian Cancer in Australia.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026
    Article
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361 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

29 authors at 16 institutions in 4 countries.

Usha MenonMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK. Electronic address: u.menon@ucl.ac.uk.
Aleksandra Gentry-MaharajMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Matthew BurnellMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Naveena SinghDepartment of Cellular Pathology, Barts Health NHS Trust, London, UK.
Andy RyanMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Chloe KarpinskyjMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Giulia CarlinoMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Julie TaylorClinical Epidemiology, Institute of Health Informatics, University College London, London, UK.
Susan K MassinghamMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Maria RaikouDepartment of Health Policy, London School of Economics and Political Science, London, UK; Department of Economics, University of Piraeus, Athens, Greece.
Jatinderpal K KalsiDepartment of Women's Cancer, Institute for Women's Health, University College London, London, UK.
Robert WoolasDepartment of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK.
Ranjit ManchandaDepartment of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK.
Rupali AroraDepartment of Cellular Pathology, University College London Hospitals NHS Trust, London, UK.
Laura CaseyDepartment of Cellular Pathology, Barts Health NHS Trust, London, UK.
Anne DawnayDepartment of Clinical Biochemistry, Barts Health NHS Trust, London, UK.
Stephen DobbsDepartment of Gynaecological Oncology, Belfast City Hospital, Belfast, UK.
Simon LeesonDepartment of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, UK.
Tim MouldDepartment of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK.
Mourad W SeifDivision of Gynaecology and Cancer Sciences, St Mary's Hospital, Manchester, UK.
Aarti SharmaDepartment of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK.
Karin WilliamsonDepartment of Gynaecological Oncology, Nottingham City Hospital, Nottingham, UK.
Yiling LiuMGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lesley FallowfieldSussex Health Outcomes Research and Education in Cancer, SHORE-C, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
Alistair J McGuireDepartment of Health Policy, London School of Economics and Political Science, London, UK.
Stuart CampbellCreate Health, London, UK.
Steven J SkatesMGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Ian J JacobsDepartment of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Women's Health, University of New South Wales, Sydney, NSW, Australia.
Mahesh ParmarMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
University College London · GBBarts Health NHS Trust · GBLondon School of Economics and Political Science · GBMassachusetts General Hospital · USMRC Clinical Trials Unit at UCL · GBBelfast City Hospital · GBCREATe Centre · GBNottingham City Hospital · GBQueen Alexandra Hospital · GBQueen Mary University of London · GBSt Mary's Hospital · GBUniversity College London Hospitals NHS Foundation Trust · GBUniversity Hospital of Wales · GBUniversity of Sussex · GBUNSW Sydney · AUYsbyty Gwynedd Hospital NHS Trust · GB

Funding

Department of Health 16/46/01Medical Research Council G0801228Medical Research Council G9901012Medical Research Council MC_UU_00004/01
6 · The paper itself

Abstract

backgroundOvarian cancer continues to have a poor prognosis with the majority of women diagnosed with advanced disease. Therefore, we undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up in UKCTOCS.

methodsIn this randomised controlled trial, postmenopausal women aged 50-74 years were recruited from 13 centres in National Health Service trusts in England, Wales, and Northern Ireland. Exclusion criteria were bilateral oophorectomy, previous ovarian or active non-ovarian malignancy, or increased familial ovarian cancer risk. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer generated random numbers to annual multimodal screening (MMS), annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. Follow-up was through national registries. The primary outcome was death due to ovarian or tubal cancer (WHO 2014 criteria) by June 30, 2020. Analyses were by intention to screen, comparing MMS and USS separately with no screening using the versatile test. Investigators and participants were aware of screening type, whereas the outcomes review committee were masked to randomisation group. This study is registered with ISRCTN, 22488978, and ClinicalTrials.gov, NCT00058032.

findingsBetween April 17, 2001, and Sept 29, 2005, of 1 243 282 women invited, 202 638 were recruited and randomly assigned, and 202 562 were included in the analysis: 50 625 (25·0%) in the MMS group, 50 623 (25·0%) in the USS group, and 101 314 (50·0%) in the no screening group. At a median follow-up of 16·3 years (IQR 15·1-17·3), 2055 women were diagnosed with tubal or ovarian cancer: 522 (1·0%) of 50 625 in the MMS group, 517 (1·0%) of 50 623 in the USS group, and 1016 (1·0%) of 101 314 in the no screening group. Compared with no screening, there was a 47·2% (95% CI 19·7 to 81·1) increase in stage I and 24·5% (-41·8 to -2·0) decrease in stage IV disease incidence in the MMS group. Overall the incidence of stage I or II disease was 39·2% (95% CI 16·1 to 66·9) higher in the MMS group than in the no screening group, whereas the incidence of stage III or IV disease was 10·2% (-21·3 to 2·4) lower. 1206 women died of the disease: 296 (0·6%) of 50 625 in the MMS group, 291 (0·6%) of 50 623 in the USS group, and 619 (0·6%) of 101 314 in the no screening group. No significant reduction in ovarian and tubal cancer deaths was observed in the MMS (p=0·58) or USS (p=0·36) groups compared with the no screening group.

interpretationThe reduction in stage III or IV disease incidence in the MMS group was not sufficient to translate into lives saved, illustrating the importance of specifying cancer mortality as the primary outcome in screening trials. Given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended.

fundingNational Institute for Health Research, Cancer Research UK, and The Eve Appeal.

Indexed as

Carcinoma, Ovarian EpithelialEarly Detection of CancerOvarian NeoplasmsAgedCA-125 AntigenFemaleHumansLongitudinal StudiesMiddle AgedRegistriesState MedicineUltrasonographyUnited KingdomCA-125 Antigen

Identifiers

PMID33991479
PMCPMC8192829
OpenAlexW3162975920

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.