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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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What is the CA-125 blood test and will it rule out Ovarian Cancer?
Ovarian cancer concerns many of my patients and I am often asked about the CA-125 (cancer antigen 125) blood test as screening for ovarian cancer. Many of you ask me if you should get the blood test for ovarian cancer and want to know what the story is. Ovarian cancer, when discovered, is often late stage and when it is it carries a dismal prognosis. Let’s talk about current guidelines for screening and new research that compares CA-125 to other tests.
Current recommendations for all-comers (not those with a family history of ovarian cancer) are that we NOT use the CA-125 as a screening test for ovarian cancer. In women with a family history (a sister or a mom with ovarian cancer) an annual CA-125 is recommended.
Who else should be screened? Some loose guidelines were published in 2008 that recommended a pelvic (transvaginal) ultrasound in any patients with PERSISTANT, unexplained bladder pressure/urinary frequency, abdominal bloating or discomfort. It is important to remember that your cervical PAP smear and pelvic exam (bimanual pelvic exam) for the most part does not pick up ovarian cancer.
Since we don’t have anything better, why not screen everyone with a CA-125? Well, because there are risks associated with doing that. Twenty percent of people with ovarian cancer have a NORMAL CA-125 so it may not be all that reassuring if your blood test is normal. Additionally, the CA-125 blood test can be elevated in benign conditions (endometriosis) and can change during the menstrual cycle. In one study it was estimated that there would be 30 false-positive CA-125 tests for every ovarian cancer detected. The potential risks associated with screening for ovarian cancer using CA-125 must be considered. While ovarian cancer is an important cause of cancer death, its incidence and prevalence in the general population are relatively low. We have to realize that a positive screening test for ovarian cancer (elevated CA-125) would probably lead to surgery (either laparoscopy or laparotomy) and a large number of healthy women may undergo these procedures unnecessarily.
What did recent findings from a large ovarian cancer screening study show? The Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (PLCO) found that no screening biomarker appears to work better than CA 125 alone in detecting ovarian cancer.
What are the details from this study? Funded by the National Cancer Institute, PLCO enrolled more than 78,000 women aged 55-74 years who were studied to test CA 125 and pelvic ultrasound for ovarian cancer. A panel of markers (CA72-4, human epididymis protein 4, etc) was tested to see if they added value to CA-125 for ovarian cancer screening. Results showed that at best, those newer markers tested in the study added “marginal improvement” over CA 125 alone.
So, where are we now? It may be feasible to have a CA-125 blood test checked and if it is > 30 (OR if a serial CA-125 shows a rising pattern) a transvaginal ultrasound can be done. It is NOT recommended to do imaging (ultrasound) as primary screening as that will likely lead to unnecessary concern and possibly surgery. There are many trials ongoing that continue to investigate whether serial markers or the addition of other epidemiologic variables can further improve current screening measures.
Stay tuned
Dr O.
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The first ultrasound results caused an intake of breath when a mass was discovered. Subsequent MRI results showed the mass was a fibroid on my right side, and a small ovarian cyst on the left.