Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography.

Abstract

Objective-To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer.Design-The serum CA 125 concentration of each subject was determined and those with a concentration : 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire.Setting-General practice, occupational health departments, ovarian cancer screening clinic.Subjects-22 000 women volunteers who were postmenopausal and aged over 45 years.Main outcome measures-Apparent sensitivity, specificity, positive predictive value, years of cancer detected.Results-41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 14 years.Conclusions-This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion ofcases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer. IntroductionThe natural course of ovarian cancer is characterised by late presentation, poor response to current treatment, and a poor prognosis. Over 70% of patients have metastatic disease at the time of presentation and the overall survival rate is less than 25%. In contrast, the small proportion of patients with early stage disease at diagnosis have a relatively good prognosis with five year survival rates over 70%. That detection of early stage disease may decrease mortality for ovarian cancer has long been recognised. The identification of the CA 125 antigen' 2 and the application of real time ultrasonography to ovarian imaging3 suggested that screening for early stage ovarian cancer may be

Clinical outcome of prophylactic oophorectomy in BRCA1/BRCA2 mutation carriers and events during follow-up

“…The combination of CA-125 and TVU was tested before in the general population Menon et al, 1999) and was shown to be a feasible screenings method. However, failure to detect more than 57% of early-stage disease is cited as the major limitation of this type of screening (Jacobs et al, 1993). More studies are required to establish in a large group of high-risk patients the sensitivity, specificity and predictive value of ovarian cancer screening, by means of pelvis examination, transvaginal ultrasound and serum CA-125 determination.…”

Progress and Challenges in Screening for Early Detection of Ovarian Cancer

“…The specificity of screening with CA125 was initially improved by the use of pelvic ultrasound as a second-line test to assess ovarian volume and morphology. Using multimodal screening incorporating sequential CA125 and pelvic ultrasound, a specificity of 99.9% and PPV of 26.8% (ϳ4 operations for each cancer) for detection of ovarian and fallopian tube cancer was achieved in 22,000 postmenopausal women (63,64). With the accumulation of data in this study, ovarian morphology has been used to refine algorithms for the interpretation of ultrasound in postmenopusal women with elevated CA125 levels (65,66).…”

Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

“…The mean PI 16,18,24 in the benign and malignant group was significantly different. Based on receiver operating characteristics curve with area under curve of 95% confidence interval, the best cut off for PI was 0.8 which has a sensitivity of 96%, specificity of 81%,positive predictive value 76%,negative predictive value 97% and P value of <0.05 was obtained which was statistically significant.…”