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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18656
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a bit of a hypochondriac and am really worrying and would

Resolved Question:

I am a bit of a hypochondriac and am really worrying and would love some reassurance. I always have a very thorough health assessment every year, including an ovarian internal scan (even though there is no history of this in my family). I just had my Bupa medical and everything came back perfect, including full bloods. The doctors suggested that instead of the ovarian scan there was now a blood test to screen for ovarian cancer. That seemed simpler than having to go back for a scan so I agreed. Anyway I had this separate blood test for C125 (or something like that) and my results came back "a little raised". Of course I immediately panicked! I then had a pelvic and ovarian scan yesterday and it was completely clear and no issues. The scanning doctor said I should have the blood test done again in 2 months as if the C125 levels continued to raise then she would start worrying. My level was 67. Of course I then googled it and saw that this is a general tumour marker and could indicate that I have cancer somewhere else in my body! I am trying to reassure myself that I feel fit and healthy, my full blood count came back perfect etc. I also read that inflammation can cause your levels to be raised? I do have sensitive skin and currently have an itchy fungal infection under both arms (caused by four years in Australia where I didn't use deodorant as I could get paraban free). I also have very mild IBS, probably brought on by being a health worrier. I will worry myself sick over the next two months about this until I get the next blood test. I know you can't give me a definitive answer, but badly need reassurance of the likelihood of it being anything to worry about. The doc says this C125 test often throws up 'false positives'. I wish I had never had the bloomin' test. If I had just had my health assessment and ovarian scan as usual I would be feeling really happy. I am a healthy weight and a vegetarian. The only other thing that has changed is I have cut out bread, potatoes, rice and pasta for about two months just to lose a couple of kilos. We go on a family holiday next week and I don't want to spoil it by worrying. Sorry for the long note. Please help! Thanks.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Thank you for using JustAnswer. I will be glad to assist you today, although there may be no good answer at this point.

The current recommendations are that there is no evidence that CA-125 screening is effective, so it is usually not done. CA-125 certainly is increased in most women with ovarian cancer, but it can be increased in a number of other conditions, some of which are cancer and some are not, and it also can be increased in about 1% of the general population. Actually, there is some variability in the prevalence of an elevated CA-125 in various studies, usually about 0.6 - 1.4% of healthy women, and can increase to 2-3% of the healthy population of elderly women. This leads to a fairly high rate of false positives. For example, in one study, 9% of women undergoing regular screening has at least one false positive result. This is done to find a cancer that will ultimately affect about 0.33% of women.

The studies that have been done to this point find that CA-125 screening is not effective as a screening test. There is hope that using the rate of increase of the CA-125 will do better as a screening test, but the initial study that is being done to look at that possibility is still being done, so the results are not yet available.

I would also note that similar studies have been done on using vaginal ultrasound to screen for ovarian cancer, and this method also is not effective as a screening modality, either alone or in combination with CA-125. Vaginal ultrasound also has a fairly high rate of false positive results, leading to unnecessary surgery.

Unfortunately, once you have checked a result, the question becomes what to do with it. I understand your frustration and wishing that it had never been done, but that decision cannot be undone. Certainly, the hope is that rechecking the test and assessing whether it is increasing would be more meaningful, but there also is no evidence that this is effective. In the screening studies, a fair number of women ultimately had their ovaries removed to determine that no cancer was present. The only other choice, though, is to ignore the result and to not check another test. If you are already anxious, then it is frequently difficult to decide to perform no further testing, but it would be a reasonable option if you can accept that course of action.

Therefore, what can be said is that it is more likely that this is a false positive, but it is difficult to prove. Rechecking the value may be reassuring if the value is decreasing or stable, but it is uncertain what an increased value may mean, so you may still be in an uncertain situation. There certainly is no reason for you to be so concerned that you cannot enjoy your upcoming vacation, but that is easier said than done for many anxious people. Long-term, you will need to decide whether you can accept not checking any further CA-125 levels, but that may be the most reasonable approach until the studies on the rate of change of CA-125 are available over the next couple years.

If you have any further questions, please let me know.

Customer: replied 3 years ago.
Thanks for coming back to me. Do you think I should be reassured because I had a full blood screening as part of my Bupa Health assessment about a month ago, or would that not really show up any serious disease? Sorry to bother you again. I do feel a little more reassured after reading your answer
Expert:  Dr. D. Love replied 3 years ago.
The fact that the other blood tests are good are generally reassuring, but do not add much for ovarian cancer screening. Ovarian cancer will typically not cause abnormalities in these other tests until fairly advanced, and since any cancer screening program is trying to identify early disease, the fact that these other tests are normal does not help determining whether there is early disease of ovarian cancer present.

You should be reassured by the data noted in my original answer, and these other lab tests are generally reassuring, but these other lab tests do not add much to the reassurance that I can offer for your risk of ovarian cancer.

Customer: replied 3 years ago.
Final question. The doctor doing my ovarian and pelvic ultrasound scan yesterday said it was clear with no tumours and that I did not have ovarian cancer. Are you saying that she should not have said that as she can't be sure?
Expert:  Dr. D. Love replied 3 years ago.
It's as sure as a doctor can be with our current tests. However, since no test has yet been proven to be effective as a screen for early ovarian cancer, it is not entirely correct to say that a normal exam means that someone has no chance of having cancer. It would be a more correct statement to say that there is no evidence of cancer on the test.

It is important to note that even tests that are good at detecting early cancer can still miss some cancers. For example, mammography is very good at detecting early breast cancer in women of a certain age, but even mammography may miss 10-20% of breast cancers. So even with a perfectly normal mammogram, it would be inaccurate to say that we are sure that the woman does not have breast cancer. It is more accurate to say that there is no evidence for breast cancer on the study.

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