It is the first question, and the most understandable. The honest answer: there is no screening — but that does not mean nothing can be done. Signs do exist, subtle but real. Knowing which ones, knowing who should be especially vigilant and when to consult: that is what, in the absence of screening, makes it possible to act early.
A cyst or mass seen on ultrasound, a raised CA-125, a suspicious image, a risk context: Dr Zeitoun reviews your tests and tells you whether specialist surgery is warranted. For symptoms without an identified mass, see your GP or gynaecologist first.
Signs that persist do not mean cancer; they simply warrant clarifying the situation with an examination and an ultrasound.
Ovarian cancer has a particular feature: unlike breast or cervical cancer, there is no screening test able to detect it in all women before it makes itself known. This absence is real — but it does not call for resignation, and that is the subject of this page.
This article is therefore not about treatments (they are detailed on the ovarian cancer page). It answers a precise, different question: can it be detected early?
You will find: why there is no screening, which signs should alert you and from when, who should be especially vigilant, a few myths to correct, and above all who to turn to as soon as a sign persists. It draws on recommendations from the INCa, the HAS and learned societies.
Screening is meant to detect a disease in people without symptoms, before it causes any symptoms. For ovarian cancer, the tests evaluated for this purpose have not proven effective.
The ovaries are two small organs located deep within the pelvis: a tumour can grow there without being felt or painful. A screening test was therefore sought. The largest trial, the UK UKCTOCS study (more than 200,000 women, final results in The Lancet, 2021), tested the CA-125 blood marker combined with ultrasound.
The verdict: despite some cancers detected earlier, this screening did not reduce mortality. This is why it is not recommended — a position shared by the US Preventive Services Task Force (a recommendation "against", 2018) and the INCa.
To remember: ineffective screening is not neutral — it leads to unnecessary tests and operations for images that turn out benign. Among gynaecological cancers, the ovary is the only one without screening: unlike uterine cancer (often revealed early by bleeding — see stage 1) or cervical cancer (screened by a smear), it has no simple early signal. "No screening" therefore does not mean "wait": it means listening to the right signs and investigating without delay — which is the whole point of what follows.
It is often believed that ovarian cancer causes no signs. In fact it frequently does — but subtle ones, easily attributed to digestion, food or stress. It is this ordinariness, more than silence, that delays the diagnosis.
| Sign that may alert | What it feels like |
|---|---|
| Bloating | A swollen, distended abdomen that does not "go down"; clothes tighter at the waist |
| Pelvic or abdominal pain | Discomfort or pain in the lower abdomen, without an obvious cause |
| Early satiety | Feeling full quickly, eating less, sometimes loss of appetite |
| Urinary symptoms | Frequent or urgent need to urinate, without infection |
Taken in isolation, each of these symptoms is most often benign. What should prompt a consultation is their combination and above all their persistence: recent signs (present for less than a year), occurring most days for several weeks, and representing a change from your usual state. This is the idea of the "symptom index" described in the literature: not a test, but a prompt to be alert.
Recent symptoms, different from what you usually experience — not a discomfort present for years.
Present most days for several weeks, without clear improvement — not a one-off episode linked to a meal or a cycle.
Which keep coming back rather than resolving on their own. It is this repetition that warrants an examination and an ultrasound.
The right reflex: faced with these signs, the first step is not to see a surgeon, but your GP, your midwife, your gynaecologist or, if the signs are mainly digestive, your gastroenterologist: they will perform a clinical examination and arrange imaging (a pelvic ultrasound) to rule out an ovarian or tubal mass. After the menopause, a mass or a cyst with an unusual appearance always deserves an opinion — see the article on the ovarian cyst, within benign gynaecological surgery.
Most ovarian cancers arise without an identifiable cause. But some women are at higher risk and deserve tailored follow-up; and some measures genuinely reduce the risk. A recent discovery has also changed the picture: many of these cancers begin in the fallopian tube, not the ovary.
The risk is higher with age (especially after the menopause), with a BRCA1/BRCA2 mutation or Lynch syndrome, a family history of breast or ovarian cancer, or certain forms of endometriosis. But most affected women have none of these factors — which is why, for everyone, signs that last should not be dismissed.
BRCA1/BRCA2 mutations are the most important risk factor — for the ovary as for breast cancer. They warrant a genetic counselling consultation and sometimes risk-reducing surgery, with close follow-up.
We now know that many cancers begin in the fimbria of the tube, from microscopic lesions, before reaching the ovary. The tube has therefore become a target for prevention.
Removing the tubes during another pelvic operation — for example a hysterectomy for a benign reason — reduces the risk without removing the ovaries or causing the menopause. It is a recommended prevention measure in several situations.
A particular situation — inherited predisposition: in women carrying a BRCA mutation, preventive removal of the tubes and ovaries (risk-reducing salpingo-oophorectomy) is offered at a defined age, once childbearing is complete. Conversely, a tumour confined to the ovary in a young woman may allow fertility-sparing management: this is notably the case with borderline tumours, whose course is very different from an invasive cancer.
A cyst or mass seen on ultrasound, a suspicious image, a raised CA-125 or a BRCA mutation: Dr Zeitoun reviews your tests, completes the work-up if needed and guides you — together with an expert network and the management of ovarian cancer at Clinique Hartmann in Neuilly.
In the absence of screening, responsiveness is what counts. If a sign lasts, the aim is not to "look for a cancer" but to clarify a situation — and, most often, to reassure you. Here, concretely, are the steps.
It all begins with a clinical examination and a pelvic ultrasound (abdominal and transvaginal), which describes any cyst or mass and estimates whether it is suspicious using standardised systems (IOTA rules, O-RADS classification). CA-125, often combined with HE4 (ROMA score), helps with this estimate — without being a screening test.
If the ultrasound is ambiguous, a pelvic MRI characterises the mass finely (benign or suspicious). It guides the decision far better than ultrasound alone in indeterminate cases.
If the image is suspicious, an opinion in gynaecological cancer surgery refines the work-up and, where needed, organises the most appropriate management.
Only tissue analysis gives a definitive diagnosis: this is pathology. Until it has spoken, a "suspicious" image remains a hypothesis, not a verdict.
This is where the surgeon comes in: Dr Zeitoun only steps in once a pelvic mass — ovarian or tubal — has been identified. Surgery then falls under surgery of the ovaries and tubes and, in case of cancer, care decided at a multidisciplinary team meeting. The detail of the treatments for ovarian cancer is on the dedicated page — this article deliberately stops at the moment of diagnosis.
Some very common beliefs delay consultation or reassure wrongly. Correcting them is part of early detection.
False. The smear and the HPV test screen for cervical cancer, not ovarian cancer. A normal smear says nothing about your ovaries. It is the most common confusion — and the most important to clear up.
False. CA-125 is non-specific: it rises in many benign situations (cyst, fibroid, endometriosis, menstruation) and can stay normal in cancer. Useful to assess a mass already seen, it does not serve to screen a woman without symptoms.
False in the vast majority of cases. Most cysts are benign, especially before the menopause. Ultrasound, MRI and CA-125 are precisely what distinguish an ordinary cyst from a suspicious mass — see is surgery needed for a cyst.
False. The disease is often found at an advanced stage, but it can be treated, including at those stages, with complete surgery and chemotherapy. Prognosis depends on many factors — see the treatments for ovarian cancer.
This article stops at diagnosis; Dr Zeitoun, a surgeon, steps in once a pelvic mass — ovarian or tubal — has been identified: to clarify it, to reassure when it is benign, or to arrange surgery when it is required.
Once an ovarian or tubal cyst or mass has been found, Dr Zeitoun reviews your ultrasound, your blood work-up and your history, requests an MRI if needed, and tells you clearly whether the situation is reassuring or whether it warrants a specialist surgical opinion.
The vast majority of ovarian masses are benign. A large part of the work is to establish this methodically — and to offer simple monitoring rather than unnecessary surgery when the image is clearly reassuring.
When an operation is needed, it is arranged within an expert network and, in case of cancer, decided at a multidisciplinary team meeting. The full management is detailed on the dedicated page.
Consultations at the practice in the 8th district of Paris (241 rue du Faubourg Saint-Honoré), surgery in Neuilly-sur-Seine. Sector 2: an estimate is provided before any operation. A second opinion is available; you can book an appointment.
No. There is no screening in women without particular risk. The largest trial, the UK UKCTOCS study (Lancet, 2021), showed that CA-125 combined with ultrasound does not reduce mortality. French (INCa) and international authorities therefore do not recommend population screening.
It often does — but non-specific ones: bloating, abdominal discomfort, early satiety, frequent urination. They are easily attributed to digestion or stress. What should raise concern is that they are new, persistent and frequent, over several weeks — reason enough to consult your GP, gynaecologist, midwife or gastroenterologist and have an ovarian or tubal mass ruled out.
Recent symptoms persisting for several weeks: bloating or a swollen abdomen, lower-abdominal or abdominal pain, feeling full quickly, frequent or urgent urination. They do not mean cancer — they are most often benign — but a clinical examination and a pelvic ultrasound are warranted if they last.
No — and this is essential to know. The smear and the HPV test screen for cervical cancer, not ovarian cancer. A normal smear says nothing about your ovaries. No routine test screens for ovarian cancer: which is exactly why the signs must be heard.
CA-125 is a useful but non-specific blood marker: it can be raised in many benign situations (cyst, fibroid, endometriosis, menstruation) and sometimes normal in cancer. It mainly helps to assess a mass already seen on ultrasound — often combined with HE4 (ROMA score) — and to monitor a known disease.
Most often, no. The vast majority of cysts are benign, especially before the menopause. Ultrasound, sometimes with MRI and CA-125, is precisely what distinguishes an ordinary cyst from a suspicious mass — see is surgery needed for an ovarian cyst. After the menopause, a cyst with an unusual appearance always deserves an opinion.
Yes. BRCA1/BRCA2 mutations and Lynch syndrome clearly increase the risk, as does a family history of breast or ovarian cancer. These situations warrant a genetic counselling consultation and, where appropriate, risk-reducing surgery of the tubes and ovaries. Most cancers, however, occur without an identified mutation.
It cannot be prevented with certainty, but some factors reduce the risk (oral contraception, pregnancies, breastfeeding). Many cancers actually arise in the fallopian tube: removing the tubes during another pelvic operation (opportunistic salpingectomy) is offered as prevention. In BRCA carriers, preventive removal of the tubes and ovaries is discussed at a defined age.
No. The disease is often found at an advanced stage, but it can be treated, including at those stages, with complete surgery and chemotherapy. Prognosis depends on many factors and does not come down to a date. Management is detailed on the ovarian cancer page.
Dr Zeitoun is a gynaecological and cancer surgeon: he reviews your ultrasound, your CA-125 and your history, requests an MRI if needed, and tells you clearly whether the situation is reassuring or whether it warrants specialist surgery, arranged within an expert network. He consults in the 8th district of Paris and operates at Clinique Hartmann in Neuilly-sur-Seine. Sector 2; a second opinion is available.
To go further — from the cyst to cancer, and towards treatments —, see also our full library of patient articles.
The reference page: work-up, types, cytoreductive surgery and treatments — the sequel to this article.
The most commonTelling a benign cyst from a suspicious mass, and understanding when surgery is required.
Between benign and malignantBorderline tumours: a course very different from an invasive cancer, often fertility-sparing.
PreventionBreast and ovary: understanding inherited risk and the options for risk-reducing surgery.
Another gynae cancerSymptoms, diagnosis and surgery of another gynaecological cancer, not to be confused.
HubCervix, endometrium, ovary, vulva: overview, stages and treatment principles.
A suspicious ovarian or tubal cyst or mass, an indeterminate image, a raised CA-125 or a BRCA mutation: Dr Jérémie Zeitoun consults in the 8th district of Paris and operates at Clinique Hartmann in Neuilly-sur-Seine, together with an expert gynae-oncology network. Bring your ultrasound reports and your CA-125 results.
This article is for information only and does not replace a medical consultation; if a sign persists without an identified mass, first speak to your GP, gynaecologist, midwife or gastroenterologist, to rule out an ovarian mass.
