During the past two decades, there have been a number of significant advances in the evaluation and treatment of ovarian cancer. These include documentation of the importance of thorough surgical staging, confirmation of the prognostic effect of aggressive tumor debulking, and demonstration of the efficacy of platin-based combination chemotherapy. Despite these advances, there has been virtually no change in the overall survival rate for patients with ovarian cancer. According to data from the Surveillance, Epidemiology, and End Results (SEER) program, the 5-year survival rate of patients with ovarian cancer has increased only from 36% in 1975 to 39% in 1990.' Since early ovarian cancer produces no symptoms, the vast majority of patients continue to be diagnosed with advanced stage disease where the prognosis is poor. Currently, only 25% of women with ovarian cancer have disease confined to the ovary at the time of diagnosis, and this percentage has not increased appreciably during the past 15 years. If we are to have a significant impact on the ovarian cancer mortality rate, we must place more emphasis on developing and testing methods for the early detection of this disease. It has been estimated, for example, that if the 25% of ovarian cancer patients currently diagnosed with Stage I tumors could be increased to 75% through early detection methods, the amount of women dying of this disease would be reduced by 50%.
One approach to early detection of ovarian cancer is screening, e.g., the application of a test or combination of tests to an at risk population of asymptomatic women in an attempt to detect early stage ovarian malignancies. According to Hulka,2 a disease should have certain specific