M any women have repeated ultrasound exams to make sure a cyst on their ovary doesn’t turn into cancer. But most of the

time that’s not necessary. Here’s why.

Follow-up tests usually aren’t helpful for low-risk cysts.Most ovarian cysts are small fluid-filled sacs that form on the ovaries. They generally don’t cause symptoms, though they are sometimes found during routine pelvic exams. Women often form such cysts as part of their menstrual cycle, and about 20 percent of postmenopausal women also develop fluid-filled cysts. Described as “simple” because they contain nothing but fluid, these common cysts rarely turn out to be cancerous in a woman of any age. But if your doctor discovers one, it should be evaluated with a vaginal ultra-sound. That’s a test in which a slender instru-ment is placed in the vagina and sound waves are used to create pictures. If that test confirms that the cyst looks benign—meaning it’s unlike-ly to turn into cancer—a small simple cyst can be safely ignored as long as it’s not causing symp-toms such as pelvic pain.

Follow-up tests can pose risks. An ultrasound exam doesn’t expose you to radia-tion and is relatively inexpensive, so repeating it may seem harmless. But many women become anxious about being called back a few weeks or months later to prove again that their cyst isn’t cancer. And by then, a woman may be in a new menstrual cycle, so the old cyst may have gone

Imaging tests for ovarian cystsWhen you need them—and when you don’t

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away on its own and a new cyst has formed, generating yet another follow-up test and more worry. Such exams can sometimes even lead to unnecessary surgery to remove a cyst or ovary. For instance, some doctors take out cysts that persist or look bigger on subsequent tests, in-cluding cysts that would never become cancer. The risks of surgery include pain, bleeding, and infection.

They can be a waste of money.A vaginal ultrasound can cost from $250 to $580 without health insurance, and an operation to remove an ovarian cyst can range from $7,000 to $10,000, according to health.costhelper.com.

So when are follow-up tests warranted? Additional imaging tests and sometimes even surgery may be justified for larger simple cysts, other kinds of cysts, and cysts that aren’t clearly identified as benign or malignant on the initial ultrasound. Cysts that are suspicious for cancer don’t need follow-up imaging but should be promptly removed, preferably by a gynecologic oncologist—a surgeon who specializes in treating ovarian cancer.

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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with ACR for Choosing Wisely, a project of the ABIM Foundation. Portions of this report are from ACR’s “Five Things Physicians and Patients Should Question” list. © 2012 ACR

Consumer Reports’ Advice

How to manage ovarian cysts Although most cysts are harmless, the following advice can address concerns you might have about ovarian cancer.

• Get a high-quality vaginal ultrasound. Radiologists, ob-gyns, and Registered Diagnostic Medical Sonogra-phers can perform the test. They should be accredited by the American College of Radiology or the American Institute of Ultrasound in Medicine. If the entire cyst can’t be seen on the vaginal scan, an abdominal ultrasound should be added.

• Consider birth control pills. They can prevent new cysts from forming but don’t make existing cysts go away.

• Report symptoms. Call a doctor if if you have sudden, severe lower abdominal pain, especially with nausea or vomiting. That may mean a cyst has burst or twisted an ovary.

• Have the right operation. A benign cyst can usually be removed with laparoscopy, a procedure that involves two or three very small cuts in the abdomen. A cyst that might be cancer requires surgery using a larger cut.

• Know the signs of ovarian cancer. They include a swollen or bloated abdomen, pressure or pain in the abdomen, difficulty eating, or feeling full quickly. Those symptoms usually stem from something else, but if they don’t go away, are frequent, or get worse, tell a doctor.