The Future of Ovarian Cancer Screening

Ovarian cancer is the deadliest of all the gynecologic cancers and the fifth deadliest cancer in women across the world. Over 150,000 women die from ovarian cancer each year. This is mainly because ovarian cancer is often found at advanced stages, when it is much harder to treat.¹

Unlike other cancers like breast or cervical cancer, there are not many effective screening tests for ovarian cancer. Researchers are very interested in finding better ways to screen for this serious condition.¹

What is a screening test?

Screening tests and diagnostic tests are different in important ways. Screening tests are routine. This means everyone will receive this test if they meet the requirements. Pap smears and mammograms are screening tests.²

The goal of screening tests is to find out whether someone is at risk of a serious disease and may need further testing. For example, if your Pap smear results are abnormal, your doctor may want to do a cervical biopsy.²

On the other hand, diagnostic tests look for a diagnosis. They are often done after a screening test has come back as abnormal or when you have symptoms of a disease. It is important to have effective screening tests because they help doctors find diseases in the early stages, when they are easier to treat.²

Current screening tests for ovarian cancer

The United States Preventive Services Task Force (USPSTF) researches diseases and gives recommendations about screening tests. Currently, the USPSTF does not recommend any routine screening tests for ovarian cancer. This is because current tests are not effective. People could be told they may have ovarian cancer when they do not.^3,4

The USPSTF believes that the harm of false diagnosis outweighs any possible benefits of current screening tests. So, experts are currently working on new ways to solve this problem.^3,4

Understanding biomarkers

Biomarkers are substances your body creates. The levels of these substances can be measured by blood tests. High or low levels of certain biomarkers can signal to your doctor that you have developed a certain disease. Each biomarker is specific to a disease. Two biomarkers that researchers look for in cases of ovarian cancer are CA125 and HE4.⁴

CA125 can be higher (elevated) in people with advanced-stage ovarian cancer. However, CA125 levels are not always a reliable sign of early-stage ovarian cancer. This is because CA125 can be slightly elevated in other situations like pregnancy, endometriosis, or during the menstrual cycle. Unfortunately, tests measuring CA125 levels can miss many cases of ovarian cancer.⁴

Researchers have found another biomarker for ovarian cancer called HE4. HE4 levels are also elevated in people with ovarian cancer. But they, too, are not a perfect predictor.⁴

There is good news. Researchers have learned that measuring CA125 and HE4 together gives a better estimate of a person’s ovarian cancer risk.⁴

RMI and ROMA

An algorithm is a set of steps to follow that help you solve a problem or answer a question. Algorithms in medicine help doctors decide who to test for diseases, how, and when. The Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA) are algorithms that help doctors decide whether they should do further testing for ovarian cancer.^1,4

RMI was first created in 1990. It looked at CA125 levels, the results of a pelvic ultrasound, and whether a woman had entered menopause. The algorithm calculated a score. If it was above 200, a woman was at high risk of having ovarian cancer and should have further testing.⁴

In 2009, another doctor proposed a new algorithm called ROMA. This algorithm looks at both CA125 levels and HE4 levels, as well as whether a woman had started menopause. Studies found that this algorithm worked better than just CA125 or HE4 levels alone. More research comparing RMI and ROMA is needed, but researchers believe that ROMA may work better than RMI.^1,4

If researchers can find screening tests that catch ovarian cancer earlier, they can treat it sooner. They hope this will lead to better outcomes and help more women survive ovarian cancer. To learn more about your ovarian cancer risk or to discuss screening, speak to your primary care doctor or gynecologist.