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Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: a prospective cohort study

^a Ovarian Cancer Screening Unit, Department of Gynaecological Oncology, St Bartholomew's Hospital and The Royal London Hospital, London EC1A 7BE, ^b Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston 02114-2521, United States

Correspondence to: Mr Jacobs.

Abstract

Objective: 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 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 >/=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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Relevant Article

Recruitment to multicentre trials—lessons from UKCTOCS: descriptive study

Usha Menon, Aleksandra Gentry-Maharaj, Andy Ryan, Aarti Sharma, Matthew Burnell, Rachel Hallett, Sara Lewis, Alberto Lopez, Keith Godfrey, David Oram, Jonathan Herod, Karin Williamson, Mourad Seif, Ian Scott, Tim Mould, Robert Woolas, John Murdoch, Stephen Dobbs, Nazar Amso, Simon Leeson, Derek Cruickshank, Ali McGuire, Stuart Campbell, Lesley Fallowfield, Steve Skates, Mahesh Parmar, and Ian Jacobs
BMJ 2008 337: a2079. [Abstract] [Full Text] [PDF]

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