CA-125: What is it good for?

As a gynecological oncologist, I often see patients who want to be tested for cancer because a close family member has just been diagnosed. Understandably, they want to be sure they don’t have it.

But there is a misunderstanding of all gynecological oncology tests. We just do not have a good screening test, even for high-risk women with a family history of the disease. OVA1 is not even a screening test, just a $650 method for deciding if a gynecological oncologist should be consulted. (By the way, a consult with me usually runs about $350).

Even ACOG's opinion is contradictory: "Screening with CA-125 measurement and transvaginal ultrasonography every 6 months has been recommended for high-risk women by the National Comprehensive Cancer Network, although evidence is insufficient to demonstrate that current screening methods improve survival rates for these women."

So, if we cannot yet impact survival, why do it?

If a patient with a family history of ovarian cancer is uncomfortable with observation, annual ultrasound and CA-125 using the family history ovarian cancer (V16.41) can be done but may not be covered. While risk reduction BSO could also be offered, I would send the patient to genetics counseling first.

References: The role of the obstetrician–gynecologist in the early detection of epithelial ovarian cancer. Committee Opinion No. 477. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:742–6.

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