CA-125 Screening Over Time: Early Detection Hope

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anicca
anicca Member Posts: 334 Member
in Ovarian Cancer #1
This story from Time, features a study volunteer named Liz Stegall.

"The most widely used test to detect these tumors is a blood test known as CA125, which picks up proteins that are common to ovarian growths. But the blood levels of these proteins also rise in women with more benign conditions, including pregnancy, endometriosis or fibroids. That renders CA125 non-specific as a screening tool, so doctors do not use it routinely in premenopausal women. (The test is used primarily in ovarian-cancer survivors, to keep track of potential recurrences.)

But the physicians at MD Anderson wondered if the test could be made more useful for screening healthy women if it were applied in a more systematic way. In the trial presented at ASCO, they tested women for CA125 proteins annually, and if any changes were detected, the volunteers were tested more frequently — every three months. If the increased screening tests revealed a continued and steady rise in the blood protein levels, the women underwent more detailed ultrasound tests of the pelvic area.
Of the 3,238 women, aged 50 to 74, studied in eight-year trial, about 7% were referred each year for more frequent three-month CA125 screenings; fewer than 1% of these women were considered high risk, and those who fell into that group were assigned to follow up with a gynecologist for further testing. Eight women were eventually found to harbor tumors, and five of them turned out to be malignant. All were caught at an early stage.

Stegall was one of the volunteers whose tumor was detected early by the screen. In her seventh year of the study, the researchers found that her CA125 level had suddenly jumped from a relatively stable 15 U/ml to 70 U/ml. (In most women, levels below 35 U/ml are considered normal.) That was enough to warrant a pelvic ultrasound and exploratory surgery, which revealed a malignant tumor. Fortunately for Stegall, her cancer was confined to a single ovary, and had not yet spread to the surrounding lymph nodes.
Stegall underwent a full hysterectomy and chemotherapy, but she is convinced that the CA125 screen saved her life. "I believe that God and my friend had a lot to do with this," she says. "I would not have been diagnosed at the stage I was, which is the stage at which something could be done.""

See the entire story:
http://www.time.com/time/health/article/0,8599,1990534,00.html

DB

Comments

  • LaundryQueen
    LaundryQueen Member Posts: 676
    #2
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    Thanks for posting this, DB.
    Thanks for posting this, DB. Maybe M.D. Anderson set their parameters lower for doing the exploratory surgery as compared to the other study that seemed to say there was no benefit to screening for ovarian cancer?

    I'm gonna see if I can find the abstract from this research.

    LQ
  • LaundryQueen
    LaundryQueen Member Posts: 676
    #3
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    LaundryQueen said:

    Thanks for posting this, DB.
    Thanks for posting this, DB. Maybe M.D. Anderson set their parameters lower for doing the exploratory surgery as compared to the other study that seemed to say there was no benefit to screening for ovarian cancer?

    I'm gonna see if I can find the abstract from this research.

    LQ

    Multiple cancer markers were used in this research
    Probably not the same research as DB referred to but still encouraging:

    http://abstract.asco.org/AbstView_102_83986.html

    A multivariate longitudinal algorithm for early detection of ovarian cancer using multiple biomarkers.

    Meeting:
    2011 ASCO Annual Meeting

    Citation:
    J Clin Oncol 29: 2011 (suppl; abstr 5031)

    Author(s): Z. Zhang, S. J. Skates, L. J. Sokoll, Z. Lu, C. H. Clarke, M. A. Hernandez, K. H. Lu, R. C. Bast; The Johns Hopkins University School of Medicine, Baltimore, MD; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas MD Anderson Cancer Center, Houston, TX

    Abstract:

    Background: Sequential measurements of CA125 have been used in a longitudinal algorithm to assess the risk of ovarian cancer. Rising CA125 followed by transvaginal sonography can achieve high specificity (99.6%) and positive predictive value (36%), but as 20% of ovarian cancers do not express CA125, sensitivity will not be optimal for preclinical disease. Multiple biomarkers may have greater sensitivity than CA125 alone. We developed and evaluated an algorithm that estimates risk of ovarian cancer using multiple biomarkers measured annually. Methods: Serum levels of CA125, CA15.3, CA72.4, CA19.9, and HE4 were evaluated in samples from the MDACC SPORE normal risk ovarian screening study (NROSS) and the GOG. The NROSS included 5 annual samples from 197 women for whom ovarian cancer was not detected and 9 cases (3 invasive ovarian cancer, 3 LMP ovarian cancer, 3 benign). The GOG contained preoperative sera from 95 Stage I ovarian cancer cases. 100 randomly selected controls together with the surgically evaluated cases in NROSS were used for model derivation. The remaining 97 from NROSS and the GOG cases were used for validation. The biomarkers were combined into a composite index using the UMSA learning algorithm. A simple longitudinal algorithm was then applied to assess the risk of cancer using both the composite index and CA125 at 98% specificity so that no more than 2% of women screened would be referred to ultrasound. Results: At a weighted average annual specificity of 98% on the first 5 time points of the longitudinal samples, the model’s sensitivity in detecting the GOG stage I cases was 81.1% (77/95). This compares favorably to a sensitivity of 73.7% (70/95) using CA125 alone at the same 5 year weighted annual specificity (p < 0.02). In longitudinal use of the composite index, the algorithm was able to detect all the ovarian cancer cases (3 invasive, 3 LMP) among the 9 surgically evaluated cases while maintaining a yearly average specificity of 98%.

    Conclusions: Multiple biomarkers can be combined in a longitudinal algorithm to improve detection of early stage ovarian cancer. Additional sample sets that include independent samples of longitudinally detected cancer cases will be needed to further validate the algorithm.

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