The Experts Speak

Article excerpt

FROM DAVID PLAUT:

Recently, a friend of mine attended a 3-day conference on Hereditary Breast and Ovarian Cancer.There were several lectures that are worth sharing.

In a conversation with a clinician at the conference, she was told by him that CA-125 is the best detector of ovarian cancer. If I assume that she did not misunderstand him, I was surprised. For some years, I have been teaching that CA-125 is a good monitor of treatment IF the base line value is elevated and that it is not a good marker for diagnosis. As of the middle of 2011, here is what I found at Pub Med to help bring us up to date on the value of CA-125 in the diagnosis of ovarian cancer.

1) Epithelial ovarian cancer is the most lethal of the gynecologic malignancies, largely due to the advanced stage at diagnosis in most patients. Screening strategies using ultrasound and the cancer antigen (CA) 125 tumor marker are currently under study and may lower stage at diagnosis but have not yet been shown to change outcomes. CA Cancer J Clin. 2011 May-Jun;61(3):183-203 by Jelovac D, Armstrong DK from Johns Hopkins.

2) An effective screening for ovarian cancer has remained elusive. The use of CA-125 or ultrasound alone does not result in adequate sensitivity or specificity for routine screening. A combination of the two modalities improves sensitivity, specificity, and positive predictive value. Using a combination of serum proteins may also improve sensitivity, specificity, and positive predictive value, but such studies have yet to be validated. No effective screening methods for ovarian cancer that have been adequately validated are available. Routine screening for ovarian cancer in the general population is not currently recommended. Cancer Control. 2011 Jan;18(1):16-21. Cragun JM. Department of OB/GYN, University of Arizona

3) The CA-125 test only returns a true positive result for about 50% of Stage I ovarian cancer patients. The CA-125 test is not an adequate early detection tool when used alone. However, several women's reproductive disorders can cause a false positive result. Endometriosis, benign ovarian cysts, first trimester of pregnancy, and pelvic inflammatory disease all produce higher levels of CA-125. …