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The role of serum CA-125 testing has evolved in patients with ovarian cancer, given a high false-positive rate associated with the test. Although its utility as a screening tool is debated, the assay could have utility for predicting recurrence, suggests Warner K. Huh, MD. If several consecutive tests return positive, this could equate to legitimate disease recurrence, panelists suggest.
If several CA-125 tests return positive, symptoms should be assessed before deciding on a treatment approach, Huh notes. In the absence of relevant CT or PET CT findings, treating a patient with a rising CA-125 level alone is not recommended.
Treating based solely on CA-125 and transvaginal ultrasound could harm the patient, notes James Tate Thigpen, MD. Studies have found that CA-125 screening led to a 9.6% false-positive rate. In women falsely detected as having ovarian cancer, 6.2% underwent surgery with a complication rate of 1.2%.
In a British study, patients with ovarian cancer were blinded to their CA-125 results. Those who received treatment based on a rising CA-125 level had similar outcomes to those who were treated based on symptoms or scan results. In general, those who received their CA-125 levels and early treatment had a poorer quality of life, Thigpen states.
CA-125 should be treated as an adjunct measure during treatment that does not impact therapy selection, believes Michael J. Birrer, MD. Scans and other tools should be utilized outside of CA-125 levels.