by Rachel Burt, Women’s Health Nurse Practitioner at Roswell OB/GYN…………………………………
A new study released by MD Andersen suggests we should take a second look at drawing CA 125 levels in postmenopausal women to help predict the development of ovarian cancer. Until the release of this new data yesterday, studies suggested we should avoid drawing CA 125 levels in healthy women. As explained in an excellent article on CancerConnect.com, CA 125 blood tests and transvaginal ultrasounds do not reduce the risk for death from ovarian cancer and may lead to unnecessary surgeries. CA 125 is a protein that is produced on the surface of ovarian cells and is measurable in the blood stream. CA 125 levels may be elevated by benign (non cancerous) conditions such as benign ovarian cysts, endometriosis, pelvic infections and pregnancy. The previous studies suggested that intervention based only on elevated CA 125 levels in otherwise healthy women resulted in too many unnecessary procedures and did not reduce the death rate from ovarian cancer. Currently, CA 125 levels are most often used by oncologists to monitor treatment success and recurrence in patients with known ovarian cancer.
The new study by MD Anderson reopens the discussion. Instead of looking at isolated CA 125 levels in women, the study looked at 4051 healthy postmenopausal women’s levels over time. The study categorized the women into low, intermediate and high risk by their initial CA 125 levels. The low risk women had CA 125 levels drawn yearly, the intermediate levels were drawn every 3 months and high risk participants were sent directly to an oncologist. Intervention was advised when a rise in CA 125 levels was detected. The results lead to the detection of 4 ovarian cancers at early stages. The importance of this result is in the ability for early detection. 70 percent of ovarian cancers are detected in advanced stages and therefore much more difficult to treat. Early detection can lead to better survival rates. The screening failed to detect 2 borderline ovarian cancers.
The study does not yet suggest a change in current practice. The screening method is continuing to be evaluated in an ongoing study in the United Kingdom with 200,000 participants addressing rates of false positives (surgeries for noncancerous reasons), the use of multiple markers to identify a greater number of ovarian cancers (only 80% of ovarian cancers result in elevated CA 125s), and reproducibility study results.
I am hopeful. Currently, our best method for detecting ovarian cancer is getting yearly pelvic exams and reporting suspicious symptoms – such as bloating, feeling fullness, pelvic pain or urinary symptoms. Unfortunately, these symptoms are so vague. And once the symptoms develop, the disease is usually in an advanced stage. Advanced stage ovarian cancer is so difficult to treat. As providers, we are so hopeful for a better method to detect ovarian cancer and help protect our patients. We are also cautious not to alarm patients and suggest unnecessary surgeries by randomly drawing CA 125 levels when they can be elevated for so many noncancerous reasons. So, for now – we are optimist that a better diagnostic method is coming in the near future.
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