• A Sharma, A Gentry-Maharaj, M Burnell, E-O Fourkala, S Campbell, N Amso, M W Seif, A Ryan, M Parmar, I Jacobs, U Menon, and UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
• Gynaecological Cancer Research Centre, University College London, EGA Institute for Women's Health, UK.
• BJOG. 2012 Jan 1; 119 (2): 207-19.

ObjectiveTo evaluate the malignant potential of ultrasound-detected ovarian inclusion cysts in the development of ovarian cancer (OC) in postmenopausal women.DesignProspective cohort study.SettingUK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).PopulationPostmenopausal women.MethodsIn UKCTOCS, women in the ultrasound group have annual scans. Women with inclusion cysts (single/multiple anechoic ≤10-mm ovarian cysts) and normal ovaries (both uniform hypoechogenicity) on their first scan were identified and followed up through cancer registry/questionnaires.Main Outcome MeasuresRelative risk (RR) of developing OC, invasive epithelial ovarian cancer (iEOC), breast cancer (BC) and endometrial cancer (EC) in women with inclusion cysts relative to those with normal ovaries. The incidence was compared with UK age-adjusted expected rates (Office for National Statistics, 2005).ResultsPostmenopausal women (n = 48,230) attended the year 1 (11 June 2001-6 December 2006) screen; 1234 (2.5%) had inclusion cysts alone and 22,914 had normal scans. By 1 November 2009 (median follow-up, 6.13 years; interquartile range, 4.96-6.98 years), four, three (one Type II), seven and 22 women with inclusion cysts and 32, 29 (20 Type II), 90 and 397 women with normal ovaries were diagnosed with OC, iEOC, EC and BC, respectively. The RR values for the respective cancers (OC [RR, 2.32; confidence interval [CI], 0.86-6.28], iEOC [RR, 1.92; CI, 0.62-5.92], EC [RR, 1.44; CI, 0.68-3.05], BC [RR, 1.12; CI, 0.73-1.73]) were not increased. There was no difference between the observed versus expected incidence rates for these cancers in women with inclusion cysts.ConclusionsPostmenopausal women with ultrasound-detected inclusion cysts do not seem to be at increased risk of ovarian or breast/endometrial (hormone-dependent) cancers.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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