Developing a meaningful screening tool for ovarian cancer will be more difficult than one might have hoped just a few years ago. This relatively rare disease often progresses with few symptoms until it is too late for curative treatments.
Adding to the differential diagnosis is the commonly used biomarker CA125 — elevated levels can suggest ovarian cancer, but also other less malignant disorders.
Ovarian cancer once was believed to be a single disease, but research now suggests that there are at least two distinct subtypes, a slow-growing, indolent form that may take from months to years to move to a more advanced stage, and a more aggressive variety driven by gene mutations. This form can move through stages 1 and 2 very quickly.
Laura Havrilesky, MD, an associate professor of gynecologic oncology, and other researchers at Duke University developed a decision model to help predict how aggressive such a cancer might be.
The researchers used data from the SEER database, which is maintained by the National Institutes of Health.
First, they applied the model using ovarian cancer as a single disease and found that screening women over age 50 had the potential to lower cancer deaths by about 15 percent.
But when they incorporated the two-subtype idea, the model predicted deaths would fall by only 11 percent.
“Catching and successfully treating the slower-growing cancers isn’t going to do as much to reduce deaths from ovarian cancer as catching the more lethal tumors,” she says.