“Don’t screen for ovarian Ca—but do pursue early detection,” by Robert L. Barbieri, MD
As Dr. Barbieri points out, the combined use of ultrasonography and CA-125 as a screening test is not cost-effective and would lead to many unnecessary interventions. But this observation is true only if you perform the test on every patient regardless of risk. Serial CA-125 levels using the established Risk of Ovarian Cancer Algorithm (ROCA) improves specificity to 99.7% and positive predictive value to 13%, according to the ROCA Screening Study Group, in a study1 presented at this year’s meeting of the American Society of Clinical Oncology. That study defined “high-risk” as:
- BRCA1 or BRCA2 mutation in a patient or her first- or second-degree relative
- two or more cases of ovarian cancer or early-onset breast cancer in a patient or her first- or second-degree relatives, or both
- Ashkenazi ethnicity and one or more cases of breast or ovarian cancer in the individual or her first- or second-degree relative, or both.
Of course, women who have a history of ovarian cancer were not included in the study, which involved 2,343 high-risk women and 19,549 CA-125 tests, totaling 6,284 woman-years of screening.
Perhaps we should target these categories of patients for screening in addition to the other pointers outlined in the editorial.
Rida W. Boulos, MD, MPH
Chair, Department of Obstetrics and Gynecology University of Illinois College of Medicine at Peoria
Dr. Barbieri responds:
High-risk women deserve a specialized care plan
I thank Dr. Boulos for her important comments alerting our readers to the clinical characteristics of women who are at very high risk of ovarian cancer. These women deserve a specialized care plan that may include regular pelvic ultrasonography and serum CA-125 measurements. In addition, a discussion of the risks and benefits of bilateral salpingo-oophorectomy may be appropriate. As Dr. Boulos suggests, clinicians may need to develop specialized processes for reliably identifying in their clinical practices the groups of women included in the study by Skates and colleagues.