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Early detection of ovarian cancer might be possible

Ovarian cancer has no symptoms in its early stages and can progress rapidly, so most cases are advanced by the time they are found

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Denise Grady
A new version of a screening test for ovarian cancer might reduce deaths from the disease, but it needs more study to determine whether the benefits hold up, researchers say. The findings come from a 14-year study of more than 200,000 women in Britain, published in The Lancet.

"We need to follow up to confirm that this is absolutely significant throughout," said Usha Menon, an author of the Lancet article and head of the gynaecological cancer centre at University College London. She said, "This is almost there, but not yet."

Her reason for caution was that the study passed only two of three tests of statistical significance, which means the apparent benefits of screening might have been due to chance. She said a few more years of monitoring the participants would resolve that question.
 

The study results have been long awaited because ovarian cancer has a poor prognosis. The disease has no symptoms in its early stages and can progress rapidly, so most cases are advanced by the time they are found. Only about 45 per cent of ovarian cancer patients are still alive five years after a diagnosis.

This year, 21,290 new cases and 14,180 deaths from ovarian cancer are expected in the United States, according to the American Cancer Society.

Past efforts to find a screening method have focused on two tests - ultrasound examinations of the ovaries, and a blood test to measure CA125, a "tumour marker" sometimes linked to early-stage disease. But in previous studies, those tests did not work: They did not lower the death rate and they produced too many false-positive results that led healthy women to have unnecessary surgery.

The Lancet study also used CA125, but in a different way. Instead of declaring a certain level abnormal, the researchers developed a mathematical formula that took into account a woman's age and the degree of change in CA125 over time, and calculated a risk score.

Experts not associated with the Lancet study agreed the test was not ready for routine use, and they varied in their optimism about it.

"It is good news because ovarian cancer is a serious problem," said Robert Smith, the vice president for cancer screening at the American Cancer Society. "The incidence is not high, but it has a high mortality rate and we've not been able to offer women much with respect to early detection. This has the potential to change that."

Tanveer P Mir, chairwoman of the board of regents of the American College of Physicians, said she thought the test had great promise and expected that the college's special task force on screening tests would evaluate the study and consider endorsing it.

Edward E Partridge, the director of the comprehensive cancer centre at the University of Alabama at Birmingham, said, "It gives us a glimmer of hope, but boy, it's a long way from being implemented as a public health policy."

Karen H Lu, the chairwoman of the department of gynaecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Centre, called the Lancet research "a solid triple, but not a home run."

"It's a lot of screening for a small amount of benefit," said Saundra S Buys, a professor of medicine and medical director of the high-risk breast cancer clinic at the University of Utah's Huntsman Cancer Institute. She called the study "an amazing accomplishment," but said the real problem is that ovarian cancer is not amenable to screening because of its lack of symptoms and aggressive growth.

An advocacy group, the Ovarian Cancer National Alliance, issued a statement that called the study promising, but said much more data analysis was needed to determine whether the test would be useful. The study was paid for by the British government and the Eve Appeal, a charitable group in Britain. Menon and several other authors have financial interests in a British company, Abcodia, that will be marketing the new version of the CA125 test.

From 2001 to 2005, the study enrolled 202,638 women ages 50 to 74 who had an average risk of ovarian cancer. The women were picked at random to join one of three groups. About half were assigned to a control group that received no screening.

Some 50,000 others were given CA125 tests, interpreted with the new formula, known as the Risk of Ovarian Cancer Algorithm. If they had abnormal findings, other tests would be done, possibly leading to surgery to remove the ovaries.

Another 50,000 had just ultrasound scans of the ovaries once a year, with more tests, if needed, to follow up on suspicious results.

Annual screenings were done until December 2011, and the women were tracked through December 2014.

©2015 The New York Times News Service

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First Published: Dec 19 2015 | 9:14 PM IST

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