Dear Dr. Gott: I read your recent column and take exception to your comments. You recommended an annual CA125 blood test for all women as a preventive step toward reducing the risk of cancer-related death. I feel you are entirely wrong and must share my reasons.
I am a practicing gynecologist and do not order a routine CA125. This is a nonspecific test that can generate abnormal results for a number of reasons, to include fibroids and endometriosis. If I referred each abnormality to my local oncologists, they would throw up their arms in dismay, having to sort out a plethora of possibilities in an attempt to determine the real cause for the elevated readings. This is an expensive process and would take precious hours.
I implore you to write a retraction.
Dear Reader: I am fully aware a CA125 is normally drawn prior to a patient beginning treatment for ovarian cancer to provide a marker for comparative purposes against future readings. The testing is also generally recommended because of a strong family history of ovarian cancer or because of questionable symptoms, such as a change in bowel habits, fatigue, low-back pain, loss of appetite, gastrointestinal upset and more.
As you pointed out, abnormalities in the testing can occur for a number of reasons and, therefore, it may not be useful as a screening test for everyone. The early, unrecognized symptoms of ovarian cancer can be overlooked all too easily. In fact, some 20,000 American women are diagnosed with ovarian cancer every year.
After a given age, men are screened routinely for prostate cancer as part of their annual testing. This PSA test more often than not results in abnormal results that must then be sorted out by a urologist or oncologist. Does this seem fair that men are allowed to “waste” the time of medical personnel but women are not? Certainly not, but I guess I was being too cautious in recommending each woman include a CA125 as part of an annual test.
If I owe an apology to all oncologists for causing unnecessary investigation, then consider it done. However, I cannot stress too strongly that those women with a family history or questionable symptoms request the test. They can first apologize to their oncologist for all efforts in getting to the bottom of a benign condition, but they can rest more easily knowing they have a clean bill of health.
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