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December 11, 2019
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‘CA-125 is a valuable tool’ for women with ovarian cancer symptoms

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Garth Funston
Garth Funston

CA-125 is a “useful test” for ovarian cancer in primary care, especially in symptomatic women aged older than 50 years, according to a presenter at the recent National Cancer Research Institute Cancer Conference in Glasgow.

“Currently, the majority of women are not diagnosed until the disease is advanced,” Garth Funston, BSc, MB, clinical research fellow at the University of Cambridge, told Healio Primary Care. “Less than half of women with ovarian cancer survive for 5 years following diagnosis. Picking up ovarian cancer as early as possible is key to improving survival, as it makes it much more likely that we can effectively treat and cure women.”

Funston and colleagues reviewed the records of 50,780 women in England with potential signs of ovarian cancer, including abdominal pain and persistent bloating, who underwent CA-125 testing. Of these women, 456 were diagnosed with ovarian cancer, and the incidence of ovarian cancer was three times higher among women aged older than 50 years than among women aged younger than 50 years.

Funston and colleagues also found that CA-125 levels of 35 U/mL or higher had a threshold positive predictive value of 15.2% (95% CI, 13.6-16.8) in women aged older than 50 years and 3.4% (95% CI, 2.5-4.4) in women aged younger than 50 years. A CA-125 level of exactly 41 U/mL in women aged older than 50 years and 76 U/mL in women aged younger than 50 years was equal to the threshold at which cancer advocates in the United Kingdom strongly encourage urgent cancer investigation or referral

“Our results show that CA-125 is a valuable tool to help identify ovarian cancer in women in primary care,” Funston said in the interview. “Perhaps the most exciting outcome is that we have been able to calculate the probability or risk for women having ovarian cancer at each CA-125 level, which will allow women and clinicians to interpret their own result in terms of the risk of ovarian cancer.”

Funston said the CA-125 test and transvaginal ultrasound are the most commonly used tests for ovarian cancer in primary care worldwide.

“At present, we don't know which test is 'better,' as no large studies have compared their performance in women who go to their general practitioner with symptoms which might be caused by ovarian cancer,” he continued. “What we do now know is that CA-125 is a useful test for ovarian cancer in this setting.”

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Funston said in a press release that his findings could be used to expand on existing clinical guidelines to improve ovarian cancer diagnosis.

According to the American Cancer Society (ACS), using transvaginal ultrasound and CA-125 for screening in women at average risk for ovarian cancer led to more testing and sometimes more surgeries, but it did not lower the number of deaths caused by ovarian cancer.

“For that reason, no major medical or professional organization recommends the routine use of [transvaginal ultrasound] or the CA-125 blood test to screen for ovarian cancer in women at average risk,” the organization states on its website.

ACS says transvaginal ultrasound and CA-125 may be offered to screen women who have a high risk for ovarian cancer due to an inherited genetic syndrome such as BRCA gene mutations, Lynch syndrome or a “strong” family history of breast and ovarian cancer. – by Janel Miller

References:

American Cancer Society. Can ovarian cancer be found early? https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html. Accessed Nov. 29, 2019.

Funston G, et al. The predictive value of CA125 for ovarian cancer in general practice: a population-based cohort study of over 50,000 women. National Cancer Research Institute Cancer Conference; Nov. 3-5, 2019; Glasgow.

Disclosures : Healio Primary Care could not confirm relevant financial disclosures at the time of publication.