Ovarian cancer screening

Article Abstract:

Ovarian cancer will kill an estimated 12,000 women in 1991. The five-year survival rate for patients with ovarian cancer was 36 percent in 1975; by 1990 it had increased a scant 3 percent to a total of 39 percent. A major impediment to improving the outlook for ovarian cancer is the fact that the majority of cases are only diagnosed once it has reached its more advanced stages. Ovarian cancer causes no symptoms in its early stages, and as a result only 25 percent of cases are diagnosed in Stage I, when 90 percent of the patients might be cured. It is estimated that if the fraction of cases diagnosed in Stage I could be increased to 75 percent, half the deaths from this cancer could be prevented. This goal will likely require the implementation of a screening program. What options are available? Since 1987, transvaginal ultrasonography has been in use. This method utilizes an ultrasonic device inserted into the vagina to obtain an ultrasound image of the ovaries. Any enlargement of the ovaries is taken as an indication for follow-up. The method is far more useful in postmenopausal women, whose ovaries do not vary during the course of the menstrual cycle. The majority of ovarian abnormalities visible in premenopausal patients are gone when a follow-up ultrasonogram is obtained. There has been some concern that the application of transvaginal ultrasonography to screening will result in a lot of unnecessary surgery as false positives are followed-up. However, some preliminary studies have found that at least 60 percent of women with positive findings on ultrasonography have benign tumors or cancer. Another potential aid to screening may be the amount of the tumor marker CA-125. This protein is elevated in about half of all patients with Stage I ovarian cancer. A woman with both positive ultrasonogram findings and elevated CA-125 is 99.9 percent certain to have ovarian cancer. Of course, the true value of a screening program can only be demonstrated by implementing it in a large test population. Now that tools for the screening of ovarian cancer have become available, such pilot tests should begin as quickly as possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasound imaging, editorial

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Coordinate elevation of serum markers in ovarian cancer but not in benign disease

Article Abstract:

Ovarian cancer is the most common cause of death from cancer of the female reproductive tract. The long-term survival rate for early-stage ovarian cancer is far greater than for more advanced stages; from 70 to 90 percent of patients with Stage I and Stage II ovarian cancers may be cured, while no more than 20 to 30 percent of patients with Stage III or Stage IV disease enjoy long-term survival. Early detection of ovarian cancer, therefore, may have life-saving potential. Unfortunately, there is not yet any procedure that is appropriate for routine screening for ovarian cancer. The discovery of tumor markers, which are usually proteins expressed exclusively or preferentially by cancer cells, was accompanied by optimism, but it has become clear that most tumor markers are not suitable for mass screening. For example, the protein CA 125 may appear in larger amounts in the blood of women with ovarian cancer, but only half the women who are developing ovarian cancer have increased amounts. Furthermore, nine percent of healthy women also have increased amounts. Therefore, an early screening test based on CA 125 will miss about half the women with ovarian cancer, and will subject many healthy women to unnecessary testing as well as unnecessary fear and anxiety. If no single satisfactory tumor marker has yet been found, it may prove practical to combine the findings from several tumor markers to yield improved detection and diagnosis of cancer. This notion was evaluated in 47 women with ovarian cancer and 50 women with noncancerous ovarian disorders. In addition to CA 125, six different specific proteins were tested in the blood. It was found that a combination of three tumor markers may be useful. While virtually all patients in the present study, with and without cancer, had high levels of CA 125, testing for the proteins CA 15-3 and TAG 72 improved the discrimination between groups. At least one of these other two markers was elevated in 63 percent of the patients with ovarian cancer, while the same was true for only 6 percent of the women with benign ovarian disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Tumor antigens, Tumor proteins, Tumor markers

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