Ovarian cancer screening

Abstract

O varian cancer is generally detected at an advanced stage and is associated with a 5-year survival rate of about 30%. However, survival rates of greater than 90% have been reported with stage I disease, thus fuelling efforts to determine the role of population screening for the detection of early disease. Recent research has focused on two screening strategies: one using ultrasound alone, the other using the serum tumour marker CA125 for primary screening followed by ultrasound as a second-line test (multimodal screening).Transvaginal or pelvic ultrasonography is used to visualize the adnexae. Benign and malignant tumours are distinguished from one another on the basis of morphology. Complex ovarian cysts with wall abnormalities or solid areas are associated with significant risk for malignant disease, 1,2 whereas unilocular ovarian cysts are associated with a less than 1% risk for ovarian cancer in asymptomatic premenopausal women.3,4 The low specificity of ultrasonography for malignant ovarian lesions, combined with recent findings of a high prevalence of benign ovarian lesions in older asymptomatic women, 5 results in many women requiring further investigations and undergoing potentially unnecessary surgery when ultrasonography alone is used for screening.Serum tumour markers for ovarian cancer exist, of which CA125 has been the most extensively studied. It is expressed by about 80% of epithelial cancers (the most common type of malignant tumour) but has limited specificity when used alone, in that it may also be increased in the presence of other cancers (pancreatic, breast, bladder, liver, lung) as well as benign disease (diverticulitis, leiomyoma, endometriosis, benign ovarian cyst, tubo-ovarian abscess, renal disease) and physiologic conditions (pregnancy and menstruation). Specificity of CA125 screening is improved by the addition of pelvic ultrasonography as a second-line test to assess ovarian lesions (multimodal strategy). The sensitivity of CA125 testing has been further refined by using sophisticated computerized calculations to aid in the interpretation of serial serum levels. 6 Overall, the data from prospective studies of screening for ovarian cancer in the general population 7 suggest that sequential multimodal screening has superior specificity and positive predictive value compared with strategies based on transvaginal ultrasonography alone. However, ultrasonography as a firstline test may offer greater sensitivity for early stage disease.Perhaps the best evidence to date on the use of screening for ovarian cancer comes from a randomized controlled trial of ovarian cancer screening using the multimodal strategy. Although the authors did not find a difference in the number of deaths from ovarian or fallopian cancer in the group that was screened (relative risk 2.0 [95% confidence interval 0.78-5.13]), they did find a significant difference in the median rate of survival in the screened group compared with the control group (72.9 months v. 41.8 months, p = 0.011). 8 Other data from prospective ...

Biomarker Testing for Ovarian Cancer: Clinical Utility of Multiplex Assays

“…The best currently available protocol for early detection of ovarian cancer, a combination of screening for elevated CA-125 and transvaginal ultrasound (TVS) in the presence of elevated CA-125 5,6 , does not meet the stringent criteria for cost-effectiveness espoused by the U.S. Preventive Services Task Force. 7 As a result, no professional group currently recommends screening for ovarian cancer in the general population.…”

Identification of O-glycosylated Proteins That Are Aberrantly Excreted in the Urine of Patients with Early Stage Ovarian Cancer

“…Currently, diagnosis of OCa is mainly reliant on imaging methods and assessment of tumor markers. However, CA125, the main tumor marker used in the diagnosis of OCa, is also elevated in numerous other cancers and benign conditions [3]. In addition, the tumor marker is not adequately sensitive for early detection, as many women with early stage OCa have normal CA125 levels [4].…”

The Role of CA-125 in Differential Diagnosis of Ascites

“…CA-125 level may al so incre a se in the pre sen ce of ot her can cers such as pe ri to nel car ci na ma to sis, pan cre a tic, bre ast, bladder, li ver, lung can cers 4,5 as well as be nign di se a ses such as li ver cirr ho sis, di ver ti cu li tis, le i om yo ma, en do met ri o sis, be nign ova ri an cyst, tu bo-ova ri an abs cess, re nal di se a se [8][9][10][11]14,20 and physi o lo gic con diti ons such as preg nancy and mens tru a ti on. 6,7,21 The ori gin of CA-125 still re ma ins unc le ar, and ova ri an, pe ri to ne al, ple u ral, en do met ri al and am ni o tic cells ha ve be en de mons tra ted to pro du ce and sec re te it. 22 By using tis su e cul tu re, Ko ba yas hi sho wed that the eu to pic and the he te ro to pic en domet ri um co uld pro du ce CA-125.…”