Screening & Prevention — MCQs
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A 50-year-old man of South Asian ethnicity attends for NHS Health Check. His BP is 136/84 mmHg, BMI 26 kg/m², HbA1c 41 mmol/mol, total cholesterol 5.8 mmol/L, HDL 0.9 mmol/L, and triglycerides 2.8 mmol/L. His QRISK3 score is 8.2%. His brother developed type 2 diabetes at age 45. What is the most appropriate next step in diabetes risk management?
A 37-year-old woman attends with her cervical screening result showing hrHPV positive with normal cytology. She had a similar result 3 years ago which resolved at repeat testing 12 months later. She is anxious about persistent infection and asks about vaccination. What is the most appropriate advice regarding HPV vaccination in her situation?
A 68-year-old man with a 3.8 cm infrarenal abdominal aortic aneurysm (AAA) detected through NHS screening attends for review. He has COPD with FEV1 48% predicted, ischaemic heart disease with previous MI, and chronic kidney disease stage 3a. He asks whether surgery is recommended. According to current evidence-based guidelines, what threshold diameter would typically prompt consideration of elective repair in this patient?
A 53-year-old woman attends for results of her NHS breast screening mammogram which shows microcalcifications in the right breast suspicious for ductal carcinoma in situ (DCIS). She asks about the significance of DCIS and whether treatment is necessary. Which of the following statements most accurately reflects the current understanding of DCIS management?
A 46-year-old woman with a BMI of 41 kg/m² attends for weight management review. She has lost 3 kg over 12 weeks following dietary advice and increased physical activity. She requests pharmacological treatment to augment weight loss. Her past medical history includes hypertension controlled with amlodipine and hypothyroidism treated with levothyroxine. What is the most appropriate pharmacological option?
A 64-year-old man attends for discussion of his NHS bowel cancer screening faecal immunochemical test (FIT) result showing 78 μg Hb/g faeces. He has no symptoms and his father died from colorectal cancer aged 76. What is the most appropriate management?
A 31-year-old woman who is 10 weeks pregnant attends for booking. She previously lived in Eastern Europe and has unclear immunisation records. Rubella IgG is negative, hepatitis B surface antigen is negative, and she is blood group O RhD-positive. What is the most appropriate management regarding immunisations?
A 55-year-old man with type 2 diabetes attends for his annual diabetic eye screening appointment but refuses mydriatic drops as he needs to drive home for an important meeting. Non-mydriatic photography is attempted but image quality is insufficient in his right eye due to small pupil size. What is the most appropriate next step?
A 42-year-old man attends for lifestyle advice. He drinks 4 pints of lager (5.2% ABV) on Friday and Saturday evenings, and a bottle of wine (750 mL, 13% ABV) on Sunday. He asks if his drinking is within safe limits. What is his weekly alcohol consumption in units?
What is the primary reason the UK National Screening Committee does not recommend routine screening for ovarian cancer in the general population?
Screening & Prevention UK Medical PG Practice Questions and MCQs
Question 61: A 50-year-old man of South Asian ethnicity attends for NHS Health Check. His BP is 136/84 mmHg, BMI 26 kg/m², HbA1c 41 mmol/mol, total cholesterol 5.8 mmol/L, HDL 0.9 mmol/L, and triglycerides 2.8 mmol/L. His QRISK3 score is 8.2%. His brother developed type 2 diabetes at age 45. What is the most appropriate next step in diabetes risk management?
- A. Reassure that HbA1c is normal and arrange repeat testing in 5 years
- B. Diagnose prediabetes and prescribe metformin for diabetes prevention
- C. Refer to NHS Diabetes Prevention Programme and arrange annual HbA1c (Correct Answer)
- D. Arrange oral glucose tolerance test to exclude diabetes
- E. Advise lifestyle modification only with HbA1c recheck in 3 years
Explanation: ***Refer to NHS Diabetes Prevention Programme and arrange annual HbA1c***- The patient's **HbA1c of 41 mmol/mol** falls within the **prediabetes** range (39-47 mmol/mol), indicating a high risk for type 2 diabetes.- Given the patient's **South Asian ethnicity**, **overweight BMI**, and **strong family history** of type 2 diabetes, referral to the **NHS Diabetes Prevention Programme (NDPP)** and **annual HbA1c monitoring** are the most appropriate management steps. *Reassure that HbA1c is normal and arrange repeat testing in 5 years*- An HbA1c of 41 mmol/mol is **not normal**; it is diagnostic of **prediabetes**, requiring active management.- Waiting **5 years** for repeat testing is inappropriate for a patient with multiple significant risk factors and an already elevated HbA1c. *Diagnose prediabetes and prescribe metformin for diabetes prevention*- While the patient has prediabetes, **metformin** for diabetes prevention is typically considered for individuals with a higher HbA1c (e.g., **≥44 mmol/mol**) or where intensive lifestyle interventions have failed.- The first-line intervention for this level of risk is a **structured lifestyle modification programme** such as the NDPP. *Arrange oral glucose tolerance test to exclude diabetes*- The **HbA1c of 41 mmol/mol** is sufficient to diagnose prediabetes; an **oral glucose tolerance test (OGTT)** is not routinely necessary at this stage.- An OGTT might be considered if the HbA1c result was equivocal or if there were conditions affecting HbA1c accuracy, which is not indicated here. *Advise lifestyle modification only with HbA1c recheck in 3 years*- Simply advising **lifestyle modification** is less effective than a **structured, evidence-based program** like the NDPP for high-risk individuals.- For individuals with prediabetes, **annual HbA1c monitoring** is recommended, not a 3-year interval, to detect progression to diabetes early.
Question 62: A 37-year-old woman attends with her cervical screening result showing hrHPV positive with normal cytology. She had a similar result 3 years ago which resolved at repeat testing 12 months later. She is anxious about persistent infection and asks about vaccination. What is the most appropriate advice regarding HPV vaccination in her situation?
- A. HPV vaccination is contraindicated in women with current hrHPV infection
- B. HPV vaccination may provide some benefit by protecting against other HPV types not currently present (Correct Answer)
- C. HPV vaccination will clear her current hrHPV infection and prevent progression
- D. HPV vaccination is only effective if given before any sexual activity and offers no benefit
- E. HPV vaccination is not cost-effective in women over 25 years and is not recommended
Explanation: ***HPV vaccination may provide some benefit by protecting against other HPV types not currently present***- Vaccination is not a treatment for **existing infections**, but it can prevent future acquisition of other **high-risk HPV types** included in the vaccine that the patient has not yet encountered.- Most sexually active adults have not been exposed to all the types covered by current **9-valent vaccines**, making private vaccination a viable option for reducing future risk.*HPV vaccination is contraindicated in women with current hrHPV infection*- There is no **clinical contraindication** to receiving the vaccine while currently positive for **hrHPV**; it is safe but simply lacks therapeutic effect for the current strain.- Current infection does not increase the risk of **adverse events** from the vaccine.*HPV vaccination will clear her current hrHPV infection and prevent progression*- The HPV vaccine is **prophylactic**, not therapeutic, and has no proven efficacy in clearing **pre-existing infections** or treating established **CIN lesions**.- Patients must be counselled that the vaccine will not change the management of their current **positive screening results**.*HPV vaccination is only effective if given before any sexual activity and offers no benefit*- While **maximal benefit** is achieved when administered prior to **sexual debut**, benefit still exists for sexually active individuals who remain at risk for new infections.- Even with a history of infection, the vaccine reduces the risk of **re-infection** or acquisition of different **genotypes**.*HPV vaccination is not cost-effective in women over 25 years and is not recommended*- Although not routinely funded by the **NHS** for women over 25, clinical guidelines state individuals can still benefit and may choose to pursue it **privately**.- Recommendations are based on **individual risk assessment** and patient preference rather than a hard age-based exclusion of clinical benefit.
Question 63: A 68-year-old man with a 3.8 cm infrarenal abdominal aortic aneurysm (AAA) detected through NHS screening attends for review. He has COPD with FEV1 48% predicted, ischaemic heart disease with previous MI, and chronic kidney disease stage 3a. He asks whether surgery is recommended. According to current evidence-based guidelines, what threshold diameter would typically prompt consideration of elective repair in this patient?
- A. 4.0 cm - repair should be offered now given his comorbidities
- B. 4.5 cm - repair threshold is lower in patients with multiple comorbidities
- C. 5.0 cm - repair threshold is higher in patients with significant comorbidities
- D. 5.5 cm - standard threshold regardless of comorbidity status (Correct Answer)
- E. 6.0 cm - repair threshold is higher given his prohibitive surgical risk
Explanation: ***5.5 cm - standard threshold regardless of comorbidity status*** - For men, the standard threshold for elective infrarenal abdominal aortic aneurysm (AAA) repair is **5.5 cm**, as studies demonstrate that the risk of aneurysm rupture significantly exceeds the risk of elective surgical mortality at this size. - The presence of significant comorbidities like **COPD**, **ischaemic heart disease**, and **CKD** does not lower this diameter threshold; rather, they influence the comprehensive assessment of surgical fitness and the choice between **open repair** or **endovascular aneurysm repair (EVAR)**. *4.0 cm - repair should be offered now given his comorbidities* - A **3.8 cm AAA** is classified as a small aneurysm, which is typically managed with **annual ultrasound surveillance** rather than immediate surgical intervention. - The patient's multiple comorbidities would increase the perioperative risk, making surgery for a small, low-risk aneurysm even less justifiable. *4.5 cm - repair threshold is lower in patients with multiple comorbidities* - Current evidence-based guidelines do not support a lower AAA repair threshold in patients with comorbidities; the risk of rupture for a **4.5 cm aneurysm** is still considerably lower than the risks associated with elective surgery. - For aneurysms between **4.5 cm and 5.4 cm**, more frequent surveillance with **ultrasound every 3 months** is generally recommended. *5.0 cm - repair threshold is higher in patients with significant comorbidities* - While **5.0 cm** is often considered the threshold for elective repair in **women** due to their generally smaller aorta and higher rupture risk at smaller diameters, it is not the standard threshold for men. - Comorbidities necessitate careful medical optimization before considering intervention, but they do not typically lead to a *higher* diameter threshold for men to be considered for repair. *6.0 cm - repair threshold is higher given his prohibitive surgical risk* - An AAA of **6.0 cm** or larger presents a very high risk of **rupture**, making the consideration of elective repair more urgent, not a reason to delay or raise the threshold further. - While extremely high surgical risk might lead to a decision to avoid intervention, the standard surveillance and referral threshold for potential repair remains **5.5 cm**, with larger aneurysms increasing immediate risk.
Question 64: A 53-year-old woman attends for results of her NHS breast screening mammogram which shows microcalcifications in the right breast suspicious for ductal carcinoma in situ (DCIS). She asks about the significance of DCIS and whether treatment is necessary. Which of the following statements most accurately reflects the current understanding of DCIS management?
- A. DCIS always progresses to invasive breast cancer if untreated and requires immediate mastectomy
- B. DCIS represents overdiagnosis in most cases and active surveillance is now standard treatment
- C. DCIS has variable natural history; treatment is recommended as approximately 25-50% may progress to invasive cancer (Correct Answer)
- D. DCIS is not a true malignancy and requires no treatment or follow-up
- E. DCIS never progresses to invasive cancer and hormone therapy alone is sufficient treatment
Explanation: ***DCIS has variable natural history; treatment is recommended as approximately 25-50% may progress to invasive cancer***- **Ductal carcinoma in situ (DCIS)** is a non-invasive breast lesion with a **variable natural history**; a significant proportion (approximately **25-50%**) may progress to invasive breast cancer if left untreated.- Current guidelines recommend **treatment** (typically surgical excision with or without radiation) to reduce the risk of subsequent invasive carcinoma, reflecting its status as a precursor lesion.*DCIS always progresses to invasive breast cancer if untreated and requires immediate mastectomy*- While DCIS carries a risk of progression, it does **not always progress** to invasive cancer; its natural history is variable, and some lesions remain indolent.- **Mastectomy** is not universally required; **breast-conserving surgery** (lumpectomy) followed by radiotherapy is often sufficient, depending on factors like tumor size and grade.*DCIS represents overdiagnosis in most cases and active surveillance is now standard treatment*- While **overdiagnosis** is a recognized concern in breast screening, it's not universally accepted that DCIS represents overdiagnosis in **most cases**, and there's no reliable way to distinguish harmless from progressive lesions.- **Active surveillance** for DCIS is currently being investigated in **clinical trials** (e.g., LORIS, LORD) but is not yet the **standard of care** outside of research settings.*DCIS is not a true malignancy and requires no treatment or follow-up*- DCIS is considered a **pre-invasive malignancy**; it consists of abnormal cells that are confined within the breast ducts but have the potential to become **invasive cancer**.- Due to its potential for progression, DCIS absolutely requires **treatment and follow-up** to prevent or detect any development of invasive disease.*DCIS never progresses to invasive cancer and hormone therapy alone is sufficient treatment*- This statement is incorrect; DCIS is well-established as a **precursor to invasive breast cancer**, particularly **invasive ductal carcinoma**.- **Hormone therapy** (e.g., tamoxifen) may be used as **adjuvant therapy** to reduce recurrence risk in **ER-positive DCIS** but is not a standalone treatment and does not replace the need for local control through surgery.
Question 65: A 46-year-old woman with a BMI of 41 kg/m² attends for weight management review. She has lost 3 kg over 12 weeks following dietary advice and increased physical activity. She requests pharmacological treatment to augment weight loss. Her past medical history includes hypertension controlled with amlodipine and hypothyroidism treated with levothyroxine. What is the most appropriate pharmacological option?
- A. Orlistat 120 mg three times daily with meals (Correct Answer)
- B. Liraglutide 3 mg once daily subcutaneously
- C. Metformin 500 mg twice daily
- D. Phentermine 37.5 mg once daily
- E. Semaglutide 2.4 mg once weekly subcutaneously
Explanation: ***Orlistat 120 mg three times daily with meals*** - **Orlistat** is the first-line pharmacological treatment for weight loss in primary care for individuals with a **BMI 30 kg/m²** (or 28 kg/m² with comorbidities) who haven't met weight loss goals through lifestyle alone. - It acts as a **pancreatic lipase inhibitor**, preventing the absorption of dietary fats and requiring dietary consultation to manage potential **gastrointestinal side effects**. *Liraglutide 3 mg once daily subcutaneously* - While licensed for weight management, it is typically reserved for **specialist weight management services** (Tier 3) and is not the standard first-line option in primary care. - It is a **GLP-1 receptor agonist** that requires specific criteria for NHS funding, such as presence of non-diabetic hyperglycemia or high cardiovascular risk. *Metformin 500 mg twice daily* - This medication is **not licensed** for weight loss in patients without prediabetes or Polycystic Ovary Syndrome (PCOS). - Although it may cause modest weight reduction as a side effect, it is Primarily used for **glycemic control** and is not indicated here for obesity management. *Phentermine 37.5 mg once daily* - This drug is currently **not licensed** for use in the UK due to historical concerns regarding cardiovascular safety and potential for misuse. - It is a **sympathomimetic amine** and is not a recommended pharmacological option in modern evidence-based guidelines for obesity. *Semaglutide 2.4 mg once weekly subcutaneously* - Similar to liraglutide, this **GLP-1 receptor agonist** is restricted to specialist services and is not routinely initiated in primary care settings under NICE guidance. - While highly effective for weight loss, the protocol dictates that **Orlistat** is used first before proceeding to injectable specialist therapies.
Question 66: A 64-year-old man attends for discussion of his NHS bowel cancer screening faecal immunochemical test (FIT) result showing 78 μg Hb/g faeces. He has no symptoms and his father died from colorectal cancer aged 76. What is the most appropriate management?
- A. Repeat FIT in 2 weeks to confirm the result
- B. Refer routinely to gastroenterology for colonoscopy
- C. Arrange urgent suspected cancer (2-week wait) referral for colonoscopy (Correct Answer)
- D. Reassure and arrange repeat FIT in 2 years
- E. Arrange CT colonography as first-line investigation
Explanation: ***Arrange urgent suspected cancer (2-week wait) referral for colonoscopy*** - According to **NICE guidelines (NG12)**, any individual with an abnormal **FIT** result from the Bowel Cancer Screening Programme must be referred via the **2-week wait (2WW)** pathway for further investigation. - A **FIT value of 78 μg Hb/g** is significantly above the standard threshold (typically 10-120 μg depending on the region/pathway), indicating a high risk of **occult bleeding** that requires gold-standard evaluation via **colonoscopy**. *Repeat FIT in 2 weeks to confirm the result* - Repeating the test is inappropriate because a single positive **FIT** in a screening context already indicates a high **positive predictive value** for pathology. - This would cause a dangerous and **unnecessary delay** in diagnosing a potential colorectal malignancy. *Refer routinely to gastroenterology for colonoscopy* - Routine referral is unsuitable given the **elevated FIT score**, which mandates an **urgent suspected cancer** pathway to ensure the patient is seen within 14 days. - Screening programs are specifically designed to detect **asymptomatic** pre-cancerous or cancerous lesions where early intervention significantly improves survival. *Reassure and arrange repeat FIT in 2 years* - This approach is incorrect as the patient has already triggered a **positive screening result** which cannot be ignored based on a lack of symptoms. - The **2-year interval** is only for those who return a negative screening result and remain within the eligible screening age range (60-74 in the UK). *Arrange CT colonography as first-line investigation* - **Colonoscopy** remains the first-line investigation in the screening pathway because it allows for both direct visualization and **biopsy** or **polypectomy** during the same procedure. - **CT colonography** is typically reserved for patients who are medically unfit for colonoscopy or where the procedure was **incomplete**.
Question 67: A 31-year-old woman who is 10 weeks pregnant attends for booking. She previously lived in Eastern Europe and has unclear immunisation records. Rubella IgG is negative, hepatitis B surface antigen is negative, and she is blood group O RhD-positive. What is the most appropriate management regarding immunisations?
- A. Administer MMR vaccine immediately to protect against congenital rubella syndrome
- B. Offer MMR vaccine in the second trimester when organogenesis is complete
- C. Advise strict avoidance of rubella contacts and administer MMR postpartum (Correct Answer)
- D. Arrange rubella IgG re-testing in 4 weeks to confirm seronegative status
- E. Offer rubella immunoglobulin prophylaxis throughout pregnancy
Explanation: ***Advise strict avoidance of rubella contacts and administer MMR postpartum***- The **MMR vaccine** is a **live attenuated vaccine**, which is strictly **contraindicated during pregnancy** due to the theoretical risk of transmission to the fetus.- Management for seronegative women involves counseling on avoiding exposure to rubella and scheduling vaccination in the **immediate postpartum period** to protect future pregnancies.*Administer MMR vaccine immediately to protect against congenital rubella syndrome*- Administering a **live vaccine** in the first trimester is contraindicated because of the potential risk of **fetal infection**.- While inadvertent vaccination usually does not lead to **Congenital Rubella Syndrome (CRS)**, it is never intentionally performed during pregnancy.*Offer MMR vaccine in the second trimester when organogenesis is complete*- **Live vaccines** are contraindicated throughout the **entire duration** of pregnancy, not just during the period of organogenesis.- The woman must wait until she has delivered before receiving the **MMR vaccine** to ensure fetal safety.*Arrange rubella IgG re-testing in 4 weeks to confirm seronegative status*- A **negative Rubella IgG** at the booking visit is a reliable indicator that the patient lacks immunity; routine re-testing is not indicated.- Resources should instead focus on **postpartum immunization** planning and education on avoiding infection.*Offer rubella immunoglobulin prophylaxis throughout pregnancy*- **Rubella immunoglobulin** does not provide reliable protection against infection or prevent fetal transmission if the mother is exposed.- It is not used for **routine prophylaxis** in seronegative pregnant women and is only considered in specific, high-risk exposure scenarios under specialist advice.
Question 68: A 55-year-old man with type 2 diabetes attends for his annual diabetic eye screening appointment but refuses mydriatic drops as he needs to drive home for an important meeting. Non-mydriatic photography is attempted but image quality is insufficient in his right eye due to small pupil size. What is the most appropriate next step?
- A. Record screening as adequate based on left eye images only
- B. Document refusal and discharge from the screening programme
- C. Arrange urgent referral to ophthalmology for slit-lamp examination
- D. Rebook screening appointment within 6 weeks with advice about transport arrangements (Correct Answer)
- E. Accept images as technically inadequate and arrange review in 12 months
Explanation: ***Rebook screening appointment within 6 weeks with advice about transport arrangements*** - When non-mydriatic photography is **insufficient** due to small pupil size or patient refusal of drops, the standard protocol is to rebook the screening. - This rebooking should occur within **6 weeks**, with clear advice for the patient to arrange **alternative transport** so that **mydriatic drops** can be safely administered for a comprehensive examination. *Record screening as adequate based on left eye images only* - Screening for diabetic retinopathy must be **bilateral** to ensure complete assessment, as retinopathy can be asymmetrical and potentially sight-threatening lesions could be missed in the unexamined eye. - Declaring an incomplete screening as adequate is a significant **clinical safety risk** and falls short of **diabetic eye screening guidelines**. *Document refusal and discharge from the screening programme* - Patients have the right to refuse specific procedures, but this should not automatically lead to **discharge** from a vital, ongoing screening program for a chronic condition. - The appropriate action is to educate the patient about the **risks of vision loss** and facilitate a complete examination through rebooking. *Arrange urgent referral to ophthalmology for slit-lamp examination* - An urgent ophthalmology referral is typically reserved for cases where multiple screening attempts fail due to **physical barriers** (e.g., dense cataracts) or if there are suspected acute pathologies. - In this scenario, the issue is a temporary logistical one (patient needing to drive), not an acute clinical finding, making an urgent referral unnecessary at this stage. *Accept images as technically inadequate and arrange review in 12 months* - Accepting technically inadequate images means a crucial part of the eye is **unexamined** for diabetic retinopathy, leaving the patient at risk of undetected or progressing disease. - Deferring review for 12 months is unsafe as it significantly delays diagnosis and potential treatment for a condition that can cause **irreversible vision loss**.
Question 69: A 42-year-old man attends for lifestyle advice. He drinks 4 pints of lager (5.2% ABV) on Friday and Saturday evenings, and a bottle of wine (750 mL, 13% ABV) on Sunday. He asks if his drinking is within safe limits. What is his weekly alcohol consumption in units?
- A. 24 units per week
- B. 28 units per week
- C. 32 units per week (Correct Answer)
- D. 36 units per week
- E. 40 units per week
Explanation: ***32 units per week*** - Alcohol units are calculated using the formula: **(Volume in mL × ABV%) / 1000**. 8 pints of lager (4544 mL × 5.2%) equals **23.6 units**, and 750mL of wine (13%) equals **9.75 units**. - The total consumption of **33.35 units** is closest to 32 units, which significantly exceeds the recommended **low-risk limit of 14 units** per week. *24 units per week* - This value underestimates the total by failing to account for either the high **ABV of the lager** or the full volume of the wine bottle. - It incorrectly suggests a level of consumption that is nearly **10 units lower** than the patient's actual intake. *28 units per week* - This total might be reached if using rounded estimates (e.g., 2 units per pint) rather than the **precise volume and ABV** provided in the clinical scenario. - Accurate calculation requires using the standard UK pint volume of **568 mL**, which yields a higher unit count for 5.2% lager. *36 units per week* - This value overestimates the patient's intake based on the provided volumes of **4 pints per night** and one bottle of wine. - It does not align with the standard calculation for **8 pints of 5.2% ABV** lager and a single bottle of 13% wine. *40 units per week* - This choice significantly exceeds the calculated value of **~33 units** and would suggest a higher frequency or volume of drinking than described. - While the patient is participating in **binge drinking**, the mathematical total of his current weekly sessions does not reach this threshold.
Question 70: What is the primary reason the UK National Screening Committee does not recommend routine screening for ovarian cancer in the general population?
- A. Ovarian cancer is too rare to justify screening costs
- B. No effective treatment is available for early-stage disease
- C. Available screening tests lack sufficient sensitivity and specificity to reduce mortality (Correct Answer)
- D. Most women with ovarian cancer have identifiable genetic mutations requiring targeted surveillance
- E. The test (CA125) is too expensive for population-level screening
Explanation: ***Available screening tests lack sufficient sensitivity and specificity to reduce mortality*** - Randomized controlled trials, such as the **UKCTOCS**, demonstrated that while screening may detect cancer earlier, it does not significantly **reduce mortality**. - Current methods like **CA125** and **transvaginal ultrasound** result in high **false-positive** rates, leading to unnecessary investigations and potentially harmful surgeries. *Ovarian cancer is too rare to justify screening costs* - While not as common as some other cancers, ovarian cancer is a significant cause of **cancer-related death** in women, making it a viable target for screening if an effective test existed. - The decision against screening is based on the **lack of clinical benefit** and mortality reduction, rather than solely the incidence of the disease. *No effective treatment is available for early-stage disease* - **Early-stage (Stage I)** ovarian cancer actually has a high **five-year survival rate** if treated promptly with surgery and chemotherapy. - The primary problem is the **inability to detect** the disease reliably at this treatable stage, not the absence of effective management options. *Most women with ovarian cancer have identifiable genetic mutations requiring targeted surveillance* - Only about **5-15%** of ovarian cancers are associated with mutations like **BRCA1/2** or Lynch syndrome, for which targeted surveillance is recommended. - The vast majority of cases occur **sporadically** in the general population, meaning focusing solely on genetic mutations would miss most patients. *The test (CA125) is too expensive for population-level screening* - The **CA125 blood test** itself is relatively inexpensive; however, the **downstream costs** of investigating numerous **false positives** are substantial. - The primary barrier to screening is the **lack of diagnostic accuracy** and clinical effectiveness in reducing mortality, not the unit cost of the test.
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