Mini Medical School 101

Recently I came across the efforts of Fran Drescher (star the Nanny). She is leading the Cancer Schmancer Movement, with the goal of increasing awareness of gynecological cancers.



Her goal is for all cancers to be diagnosed in stage one, when the disease is most easily and most effectively treated. An advocate for women understanding and taking control of their bodies, I applaud her efforts.

In a recent interview she was speaking about screening tests, in particular the use of vaginal ultrasound for detection of ovarian cancer. She was expressing the concern that it is not covered by insurance and therefore not available to women.

Respectfully I would like to clarify this issue. I believe it to be an important one and will be an excellent topic for my 1st Mini Med School Post.

A screening test is only useful if it:

Is capable of detecting disease
Has more benefit than risk
Makes a difference in the outcome of the disease


In the case of ovarian cancer, vaginal ultrasound is not an effective screening tool. The problem is the frequency of false-positive results. False-positive results are when the test suggests an abnormality when nothing is really wrong.

Doctors believe this because in one study (Jacobs Lancet 1988) 5 cancers were found among 5,489 asymptomatic patients who received 14,356 vaginal ultrasounds. In a second study (Andolf et al Br J ObGyn 1986) one cancer was found in 805 high risk women who were screened by vaginal ultrasound, BUT 38 patients in the study had exploratory surgery to follow-up on false positive test results. These numbers (the frequency of disease in a population and complication rate from screening) are used by physicians to determine if screening tests work.

Sometimes people believe that because a test is available it must be good. This is not always true. The well-informed patient should understand this.