Authors:

Jacobs IJ. Skates S. Davies AP. Woolas RP. Jeyerajah A. Weidemann P. Sibley K. Oram DH.

Institution:

Ovarian Cancer Screening Unit, Department Gynaecological Oncology, St Barts Hospital-Royal London Hosp,London EC1A 7BE; United Kingdom.

Title:

Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: A prospective cohort study (1996-1594).

Source:

BMJ. Vol 313(7069) (pp355-1358), 1996.

Abstract:

Objectives:

To determine the risk of invasive epithelial ovarian cancer and fallopian tube cancer associated with a raised concentration of the tumour marker CA 125 in asymptomatic postmenopausal women.

Design:

Serum CA 125 concentration was measured annually in study participants for one to four years. Participants with a concentration<= 30 U/ml were recalled for abdominal ultrasonography. Follow up was by annual postal questionnaire.

Setting:

General practice, occupational health departments, ovarian cancer screening unit in a teaching hospital. Subjects - 22,000 volunteers, all postmenopausal women<= 45 years of age; recruited between 1 June 1986 and 1 May 1990. Intervention - Surgical investigation if the ultrasound examination was abnormal.

Main Outcome Measures:

Cumulative and relative risk of developing an index cancer (invasive epithelial ovarian cancer or fallopian tube) after a specified CA 125 result.

Results:

49 index cancers developed in the study population during a mean follow up of 6.76 years. The overall cumulative risk of developing an index cancer was 0.0022 for the entire study population and was lower for women with a serum CA 125 concentration< 30 U/ml (cumulative risk 0.0012) but was appreciably increased for women with a concentration<= 30 U/ml (0.030) and > 100 U/ml (0.149). Compared with the entire study population the relative risk of developing an index cancer within one year and five years was increased 35.9-fold (95% confidence interval 18.3 to 70.4) and 14.3-fold (8.5 to 24.3) respectively after a serum CA 125 concentration<= 30 U/ml and 204.8-fold (79.0 to 530.7) and 74.5-fold (31.1 to 178.3) respectively after a concentration<= 100 U/ml.

Conclusion:

- CA 125 is a powerful index of risk of ovarian and fallopian tube cancer in asymptomatic postmenopausal women.

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