Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography

Abstract

Objective-To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer.Design-The serum CA 125 concentration of each subject was determined and those with a concentration : 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire.Setting-General practice, occupational health departments, ovarian cancer screening clinic.Subjects-22 000 women volunteers who were postmenopausal and aged over 45 years.Main outcome measures-Apparent sensitivity, specificity, positive predictive value, years of cancer detected.Results-41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 14 years.Conclusions-This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion ofcases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.

Screening for ovarian cancer

“…The Jacobs trial confirmed previous evidence4 that an acceptable positive predictive value is achieved by selecting women for evaluation by imaging on the basis of CA125 serum measurement. Neither transvaginal sonography nor CA125 is specific enough when used alone, but when the decision rule for surgical referral requires that both tests are positive the positive predictive value is 20%.…”

Features of ovarian cancer in Lynch syndrome (Review)

“…In asymptomatic and postmenopausal females, the positive predictive value was 2% for detecting ovarian cancer using CA125 alone (36,37). Furthermore, in a large-scale ovarian cancer screening study of 22,000 subjects using CA125 alone, the sensitivity was 58% and the specificity was 98.5% (38). The specificity is extremely significant for ovarian cancer screening.…”

Fortnightly review: Hereditary ovarian carcinoma

“…For example, CA 125 measurement detects only about 50% of stage 1 ovarian tumours 28. In the general population, clinical examination, transabdominal29 and transvaginal 30 31 ultrasonography, and serum CA 125 screening tests,32 either alone or in combination,33 have been assessed as potential screening tests in various settings. However, no test or combination of tests has yet proved to be practical for population screening.…”