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How Should We Screen for Ovarian Cancer?

I am frequently asked about screening tests for ovarian cancer. This is a dreaded disease which strikes without warning, and can frequently be deadly. Wouldn’t it be great if we could detect it early and prevent its terrible consequences? You may receive the same emails that I do, presumably from Gene Wilder, encouraging women to have a CA-125 blood test; Gene’s wife, Gilda Radner, died from ovarian cancer. Unfortunately, it’s not a very good test. And what’s worse, it’s about the best test we have. We have studied a variety of blood tests, sonograms, and even screening by symptoms, as a means of early reliable detection, but nothing has yet proved fruitful. This puts ovarian cancer in good company – there are more than 200 types of cancer arising in more than 60 organs in humans, and yet we only have screening tests for six cancers! We screen for breast cancer with mammograms, cervical cancer with Pap smears and HPV tests, colon cancer with colonoscopies, lung cancer (in at-risk patients) with chest X-rays or CT scans, prostate cancer with digital rectal exams and (controversial) PSA blood tests, and skin cancers by physical exam. The somewhat reassuring statistic is that only 1.4% of women will be diagnosed with ovarian cancer. The frustrating fact remains that CA-125 tests are not a good screening test. Dr. Otis Webb Brawley is the chief medical officer of the American Cancer Society, and he has written an eloquent discussion of the limits of Ca-125 screening for ovarian cancer, which you can read here:

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