Ovarian cancer diagnosis studies continue with progress

When the enormously talented Gilda Radner died at the too— young age of 42 from ovarian cancer, her husband, Gene Wilder, became a man with a mission. He went on radio and television telling women that there was a “simple blood test” that could detect early ovarian cancer. If only that were true.

Ovarian cancer is a scary disease, and it’s hard to diagnose early. While ovarian cancer can be symptomatic early on, the symptoms are vague — like abdominal bloating, gas, nausea, fatigue and pelvic discomfort. Who among us hasn’t felt one or two of those symptoms now and then? If the symptoms are persistent, that is worrisome, there are so many more common ailments that can lead to those complaints. Therefore, early ovarian cancer really has no symptoms to speak of.

What about the blood test? Wilder was talking about the test for a “tumor marker” called CA125. CA125 is produced by ovarian cancer cells, other female cancers and even by cancers quite distanced from those female parts. In the early stages of ovarian cancer, the chemical may not be released, so CA125 flunks as an early screening test. In addition, perfectly benign, and much more common, conditions such as menstruation, pregnancy and endometriosis can raise the blood levels of CA125. This makes the CA125 test virtually useless for premenopausal women like Radner.

The problem with screening for ovarian cancer is that it is not as common as, say, breast or colon cancer, two cancers that definitely benefit from early screening and treatment. When a condition is not very prevalent in the group that is being screened, we run the risk of many more false positive tests than true positive ones. Then what do we do? The only way to know for sure is to take out the ovaries, and that seems awfully drastic if the ovaries were perfectly fine to begin with.

Researchers reporting at the Society of Gynecologic Oncologists Annual Meeting have come up with criteria for detecting ovarian cancer in post-menopausal women without symptoms. Now, Gilda was not postmenopausal, so this study wouldn’t apply to her. But since the vast majority of ovarian cancers happen in the older age group, this study is worth our attention.

More than 28,000 women are taking part in this study, which looks at screening asymptomatic women ages 54 to 77 for ovarian cancer. The study uses tests that are easy to get right now—CA125 and vaginal ultrasound. Doctors have been using these tests for years to look for ovarian cancer, but these researchers have come up with a set of criteria that allows for more accurate interpretation of the test results. Using these criteria, the researchers were able to accurately detect 93 percent of the advanced ovarian cancers and 87 percent of the early cancers in these asymptomatic women.

But the downside of false positive tests was still present in the study. Based on the criteria the researchers identified, 891 women had surgery, with 48 cancers discovered. The accuracy got better when serial, yearly tests were considered, but still, that’s an awful lot of unnecessary surgery.

Since the study is ongoing, we’ll be getting more information as more results are analyzed. So far, the research sheds no new light on the impact screening has on ovarian cancer deaths. Nor do we know the cost of screening for each cancer identified, and that is important information in an era of astronomically rising health care costs. And so, as we say, more research is needed before we can recommend the routine use of CA125 and vaginal ultrasound for ovarian cancer screening.

As for Gilda, she had a family tree riddled within ovarian cancer. That her vague early symptoms did not lead to further investigation is a tragedy, and so we lost Roseanne Roseannedanna and Emily Litella and Barbara Wawa. I miss them.

Dr. Stacie Bering is a Spokane physician. Contact her with general questions and topics for future columns by mail at Dr. Stacie Bering, Features Department, The Spokesman-Review, P.O. Box 2160, Spokane WA 99210 or by e-mail at doctorstacie@mac.com. She cannot answer personal medical questions in her column.