Study designs of evaluations included in the review
Performance of the screening tests: only prospective screening studies (including randomised controlled trials, RCTs) were eligible for inclusion.
Adverse effects of screening: for studies assessing the psychological effects of screening, all study designs were eligible for inclusion. For assessing the adverse effects of surgery, only studies with more than 50 patients were eligible.
Cost-effectiveness of screening for ovarian cancer: any study reporting cost data for ovarian cancer screening was also eligible for inclusion.
Specific interventions included in the review
Studies evaluating any test or combination of tests to detect ovarian cancer were eligible for inclusion. The screening tests used in the included studies were ultrasound scanning, the measurement of the tumour marker cancer antigen 125 (CA-125) in serum, and colour Doppler imaging.
Reference standard test against which the new test was compared
The included studies were required to follow-up women testing positive with diagnostic surgery. In the review, the follow-up at one year was used to determine the sensitivity of the screening tests.
Participants included in the review
Performance of the screening tests: only studies of women with no clinical symptoms of ovarian cancer were eligible for inclusion. Studies of women already scheduled for surgical investigation were excluded.
Adverse effects of screening: for the assessment of psychological effects of screening, studies in the general population or in women at high risk were eligible for inclusion.
Outcomes assessed in the review
Performance of the screening tests: no inclusion criteria relating to outcome measures were specified. The outcome measures in the review were the calculated sensitivity, specificity, positive predictive value (PPV) and false-positive rates.
Adverse effects of screening: studies were eligible for inclusion if they reported on the surgical complications of procedures used in diagnosing ovarian cancer (such as open or laparoscopic oophorectomy), or on the psychological outcomes of screening. For studies on the adverse effects of surgery, studies of simultaneous oophorectomy and hysterectomy and studies of the long-term effects of oophorectomy were excluded.
How were decisions on the relevance of primary studies made?
For studies evaluating the performance of screening tests, three reviewers independently assessed the retrieved abstracts and titles for relevance; the full versions of selected papers were independently assessed for inclusion by two reviewers.