ASK THE DOCTOR: Screening for ovarian cancer not helpful, can cause anxiety
By DR. JIM MITTERANDO
The Patriot LedgerQ Would you please comment on the E-mail that is circulating on the Internet regarding the CA-125 blood test to screen for ovarian cancer?
A Ovarian cancer is not that common. It affects one in 10,000 women per year; women have a 1 percent lifetime risk of dying from ovarian cancer. Unlike breast and cervical cancers, ovarian cancer does not have a good screening test to detect it early. Also, screening does not reduce the risk of dying from ovarian cancer.
Advertisements and web sites offer to check the CA-125 blood test for ovarian cancer screening. CA-125 is a tumor marker that is often elevated in women with ovarian cancer. Unfortunately, CA-125 is not a good screening test - it misses half of early ovarian cancers and results in many false positives. One percent of healthy women have an elevated CA-125 level but do not have ovarian cancer. If a woman has an elevated CA-125 she has a 98 percent chance that it is a false positive test; this means that 49 women would have a false positive test requiring additional tests and surgeries for every one woman with ovarian cancer.
CA-125 is not useful as a screening test in asymptomatic people, but can be helpful as a diagnostic test when people have suspicious findings on ultrasound or CT-scan.
Unfortunately, pelvic exams and ultrasounds are not very good at detecting ovarian cancer, as well. Ultrasounds are notorious for false positive results that provoke anxiety and extra testing. Ultrasounds often find incidental ovarian cysts. Ovarian cysts are fluid filled sacs on the ovary. Most cysts are benign; the ovary makes a cyst after releasing an egg, which then usually gets absorbed by the body.
The American College of Physicians and the American College of Obstetricians and Gynecologists advise against screening for ovarian cancer since it does not save lives. The chances are far greater that these tests will be falsely positive, resulting in anxiety, further unnecessary tests, surgery and risks.
Recent E-mails and advertisements encouraging testing are taking advantage of fears and publicity regarding this cancer and should be ignored.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Copyright 2002 The Patriot Ledger
Transmitted Tuesday, September 10, 2002