Can a Multimarker Assay Improve Screening for Ovarian Cancer?
Almost three quarters of ovarian cancer cases are diagnosed at advanced stages, making this disease the most lethal gynecologic malignancy in U.S. women. Using sera from a total of 1400 healthy women, and women with early- and late-stage ovarian cancer, investigators evaluated 96 candidate serum proteins to pinpoint and validate a panel of four biomarkers (CA 125, HE4, CEA, and VCAM-1) that best distinguished sera from women with early ovarian malignancies from those of healthy controls. Sensitivity of the biomarker panel was 86% and 95% for identifying early- and late-stage ovarian cancers, respectively, with 98% specificity; moreover, the panel performed substantially better than CA 125 alone.
Comment: The authors stress that this multimarker panel must be evaluated further, against other serum banks, which might yield additional biomarkers to optimize detection of early ovarian malignancies in asymptomatic women. Moreover, the panel’s screening utility might be enhanced through serial use or as a first-line test in conjunction with secondary vaginal ultrasound imaging (JW Womens Health Apr 16 2009). An editorialist notes that, stage for stage, ovarian and breast cancer have similar prognoses, which underscores the importance of early detection. During the next decade, we can expect that multimarker assays will be applied to real-world screening of menopausal women, in whom prevalence of ovarian cancer is very low. Even more importantly, future studies will be designed to assess whether two-stage screening with multimarker panels, followed by imaging, can lower mortality related to this uncommon but highly lethal disease.
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