Evidence of Benefit
Among women in the general U.S. population, simultaneous screening with CA 125 and TVU compared with usual care did not reduce ovarian cancer mortality. Diagnostic evaluation following a false-positive screening test result was associated with complications.
In the UKCTOCS trial, multimodality screening included a two-stage screening arm with CA 125 measured and used to estimate an ovarian cancer risk score. That risk score determined follow-up. Elevated risk was followed with a transvaginal ultrasound. Intermediate risk scores were followed up with a repeat CA 125 measure and recalculation of the risk score, if risk remained intermediate or higher than an ultrasound. The reported sensitivity and specificity scores from the prevalent screen for the multimodality screening arm were 89.4% and 99.8% overall; 89.5% and 99.8% for invasive cancers.
Proteomics has been used to identify patterns or specific serum markers that may be used in place of, or in conjunction with, CA 125 measurements for the early detection of cancer.[25,26] These studies have been small case-control studies that are limited by sample size and by the number of early-stage cancer cases included. Further evaluation is needed to determine whether any additional markers have clinical utility for the early detection of ovarian cancer.
- Smith LH, Oi RH: Detection of malignant ovarian neoplasms: a review of the literature. I. Detection of the patient at risk; clinical, radiological and cytological detection. Obstet Gynecol Surv 39 (6): 313-28, 1984.
- Hall DJ, Hurt WG: The adnexal mass. J Fam Pract 14 (1): 135-40, 1982.
- Keettel WC, Pixley EE, Buchsbaum HJ: Experience with peritoneal cytology in the management of gynecologic malignancies. Am J Obstet Gynecol 120 (2): 174-82, 1974.
- Higgins RV, van Nagell JR Jr, Woods CH, et al.: Interobserver variation in ovarian measurements using transvaginal sonography. Gynecol Oncol 39 (1): 69-71, 1990.
- Buys SS, Partridge E, Greene MH, et al.: Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 193 (5): 1630-9, 2005.
- Partridge E, Kreimer AR, Greenlee RT, et al.: Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol 113 (4): 775-82, 2009.
- Menon U, Gentry-Maharaj A, Hallett R, et al.: Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 10 (4): 327-40, 2009.
- Bast RC Jr, Feeney M, Lazarus H, et al.: Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest 68 (5): 1331-7, 1981.
- Bast RC Jr, Klug TL, St John E, et al.: A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med 309 (15): 883-7, 1983.
- Jacobs I, Stabile I, Bridges J, et al.: Multimodal approach to screening for ovarian cancer. Lancet 1 (8580): 268-71, 1988.
- Gohagan JK, Levin DL, Prorok JC, et al., eds.: The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Control Clin Trials 21(6 suppl): 249S-406S, 2000.
- Niloff JM, Knapp RC, Schaetzl E, et al.: CA125 antigen levels in obstetric and gynecologic patients. Obstet Gynecol 64 (5): 703-7, 1984.
- Haga Y, Sakamoto K, Egami H, et al.: Evaluation of serum CA125 values in healthy individuals and pregnant women. Am J Med Sci 292 (1): 25-9, 1986.
- Jacobs I, Bast RC Jr: The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod 4 (1): 1-12, 1989.
- Zurawski VR Jr, Orjaseter H, Andersen A, et al.: Elevated serum CA 125 levels prior to diagnosis of ovarian neoplasia: relevance for early detection of ovarian cancer. Int J Cancer 42 (5): 677-80, 1988.
- Helzlsouer KJ, Bush TL, Alberg AJ, et al.: Prospective study of serum CA-125 levels as markers of ovarian cancer. JAMA 269 (9): 1123-6, 1993.
- Kobayashi H, Yamada Y, Sado T, et al.: A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 18 (3): 414-20, 2008 May-Jun.
- Jacobs I, Davies AP, Bridges J, et al.: Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 306 (6884): 1030-4, 1993.
- Einhorn N, Sj�vall K, Knapp RC, et al.: Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer. Obstet Gynecol 80 (1): 14-8, 1992.
- Einhorn N, Bast R, Knapp R, et al.: Long-term follow-up of the Stockholm screening study on ovarian cancer. Gynecol Oncol 79 (3): 466-70, 2000.
- Jacobs IJ, Skates SJ, MacDonald N, et al.: Screening for ovarian cancer: a pilot randomised controlled trial. Lancet 353 (9160): 1207-10, 1999.
- Vasen HF, Tesfay E, Boonstra H, et al.: Early detection of breast and ovarian cancer in families with BRCA mutations. Eur J Cancer 41 (4): 549-54, 2005.
- Olivier RI, Lubsen-Brandsma MA, Verhoef S, et al.: CA125 and transvaginal ultrasound monitoring in high-risk women cannot prevent the diagnosis of advanced ovarian cancer. Gynecol Oncol 100 (1): 20-6, 2006.
- Buys SS, Partridge E, Black A, et al.: Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 305 (22): 2295-303, 2011.
- Zhang Z, Bast RC Jr, Yu Y, et al.: Three biomarkers identified from serum proteomic analysis for the detection of early stage ovarian cancer. Cancer Res 64 (16): 5882-90, 2004.
- Petricoin EF, Ardekani AM, Hitt BA, et al.: Use of proteomic patterns in serum to identify ovarian cancer. Lancet 359 (9306): 572-7, 2002.