Wednesday, February 27, 2008

A Test for Ovarian Cancer?

Researchers report that a new blood test combining six different biomarkers can detect early-stage ovarian cancer with 99.4% accuracy. (For the scientifically inclined, the six markers are leptin, prolactin, osteopontin, insulin-like growth factor II, macrophage inhibitory factor, and CA-125.)

This matters to me because I had a big ovarian cancer scare when I was 26. I'd been feeling fatigued and vaguely sick for months when an ultrasound picked up a mass on my right ovary. A subsequent CT scan indicated it was solid. Everyone got good and scared; my usually calm mom was so freaked, she ran a couple of red lights while driving me to the doctor. I confronted the possibility of never having kids even if I didn't die from it.

I went into surgery, only to wake up with all my parts intact. The doctors were all so red-faced they wouldn't say anything except that the laparoscopy showed no signs of a cyst, much less cancer. Another doctor who wasn't involved in the snafu later theorized that I'd had a cyst that looked solid on the CT because it contained blood, and that had burst during a rough exam. That was a good enough answer for me. I was still left with the first real intimation of my own mortality.

The new test, if it pans out in the phase III clinical trials already underway, will be a huge blessing for a whole host of reasons.

1. The biggie: Ovarian cancer won't so often amount to a death sentence. It might even do for ovarian cancer what the Pap smear did for cervical cancer: transform it into a scary but usually curable disease, instead of a major killer. Now, it's the fifth leading cause of cancer deaths among American women, accounting for an estimated 15,280 deaths in 2007 according to the American Cancer Society. When it's found early, still confined to the ovaries, the five-year survival rate is 93%, as compared to 45% for all cases. But fewer than 20% of all ovarian cancers are caught that early, again according to the ACS. It's hard to diagnose because its physical symptoms are quite unspecific: bloating and pelvic heaviness, indigestion, nausea, back or pelvic pain, vaginal bleeding or abnormal periods, and weight gain or loss.

2. The best test currently available gives 1 in 20 women a false positive result indicating cancer where none is present. The new test will mess with people's minds only 4 times out of 1000. If you're one of those women faced with fear of impending death, that's a huge difference – as I learned the hard way.

3. This improved accuracy will avoid unnecessary CT scans (which are costly and expose the patient to considerable radiation).

4. Better accuracy will avoid unnecessary surgeries – again, I can testify what a boon this will be.

5. Women who carry one of the BRCA genetic mutations, which predispose them to both breast and ovarian cancer, may be able to choose watchful waiting without quite so much worry. Currently, many women with the BRCA mutation choose elective removal of their ovaries, but that plunges them into instant menopause at a young age.

The big open question – assuming that the test proves itself in its final trials – is whether insurance companies will cover it, and if so, for whom.

To learn more about ovarian cancer, visit the National Ovarian Cancer Coalition or the National Cancer Institute. For the original study, go to the abstract; you can download the full article for free from there.

Photo by Flickr user herby fr used under a Creative Commons license.


Elaine Williams said...

HI: Thanks for stopping by my blog. You know, this post above really struck home with me. A good friend of mine for about 17 years just found out two weeks ago she has endometrial cancer. It's stage three. It really makes me crazy inside, and I want to cry at the same time, recalling what my husband went through with cancer. I'm doing the best I can to help her own, physically and emotionally, but it really makes me appreciate all the more what I have in my life. Thanks again for a wonderful post and best to you and yours. :-)

Sungold said...

Hi Elaine. I will be hoping for the best with your dear friend. That is so hard. I'm sure you're a wonderful support to her, but my, you've had to bear an awful lot.

I think once you've been through an ordeal with cancer it's only natural - and perfectly okay - to feel the sort of anger you're experiencing. I felt furious when my husband was diagnosed with a second, unrelated cancer last spring, two years after he was pronounced in remission from Hodgkins lymphoma.

I'm fortunate that he survived both, but he has significant QOL issues from each, some of which effect me too in pretty serious ways. Most of these effects are too private, and too much *his* stuff, for me to write about here. I suppose that's one reason I find myself writing about cancer in a broader sense - trying to come to terms with the residual effects and all the feelings they evoke.

Warmest wishes to you, Elaine.