Design-Serum CA 125 concentration was measured annually in study participants for one to four years. Participants with a concentration equal to or greater than 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 equal to or greater than 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 cancer of the ovary 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 equal to or greater than 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 equal to or greater than 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 equal to or greater than 100 U/ml.

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

Ovarian Cancer Screening Unit,
Department of Gynaecological Oncology,
St Bartholomew's Hospital and The Royal London Hospital,
London EC1A 7BE

Ian J Jacobs,
consultant gynaecological oncologist

Ann Prys Davies,
research fellow

Robert P Woolas,
gynaecological oncology fellow

Arjun Jeyerajah,
research fellow

Pru Weidemann,
research nurse

Karen Sibley,
nursing director of screening unit

David H Oram,
consultant gynaecological oncologist

Department of Medicine,
Harvard Medical School and Massachusetts General Hospital,
Boston 02114-2521,
United States

Steven Skates,
associate professor

Correspondence to: Mr Jacobs.

Design-Randomised parallel controlled trial.

Subjects-46 healthy men and women aged 19 to 69. Intervention-Consumption of five to six strong cups (0.9 litres) a day of either cafetiere (22 subjects) or filtered coffee (24 subjects) for 24 weeks.

Main outcome measures-Mean changes in serum aminotransferase and lipid concentrations.

Results-cafetiere coffee raised alanine aminotransferase concentration by up to 80% above baseline values relative to filtered coffee. After 24 weeks the rise was still 45% (9 U/1 (95% confidence interval 3 to 15 U/1), P = 0.007). Alanine aminotransferase concentration exceeded the upper limit of normal in eight of the 22 subjects drinking cafetiere coffee, being twice the upper limit of normal in three of them. cafetiere coffee raised low density lipoprotein cholesterol concentrations by 9-14%. After 24 weeks the rise was 0.26 mmol/l (0.04 to 0.47 mmo1/1) (P=0.03) relative to filtered coffee. Triglyceride concentrations initially rose by 26% with cafetiere coffee but returned close to baseline values within six months. All increases were reversible after the intervention was stopped.

Conclusions-Daily consumption of five to six cups of strong cafetiere increases in serum alanine aminotransferase concentration. The effect does not subside with prolonged intake. High intakes of coffee brews rich in cafestol and kahweol may thus be responsible for unexplained increases in this enzyme activity in apparently healthy subjects. cafetiere coffee also raises low density lipoprotein cholesterol concentration and thus the risk of coronary heart disease.

Department of Human Nutrition,
Wageningen Agricultural University,
Bomeneg 2,
6703 HD Wageningen,
the Netherlands

Rob Urgert,
nutrition researcher

Saskia Meyboom,
dietitian

Marjan Kuilman,
nutrition researcher

Henny Rexwinkel,
nutrition researcher

Maud N Vissers,
nutrition researcher

Mariska Klerk,
nutrition researcher

Martijn B Katan,
professor