EARLY DETECTION OF OVARIAN-CANCER - BACKGROUND, RATIONALE, AND STRUCTURE OF THE YALE EARLY DETECTION PROGRAM

Ovarian cancer has received national attention as a highly virulent di sease. Its lack of early warning symptoms and the failure to develop h ighly sensitive screening tests have led some physicians to recommend prophylactic oophorectomies to women with relatives who have had ovari an cancer. Others have recommended routine screening of otherwise norm al women for CA 125, a circulating tumor marker, and ultrasound examin ations. Each of these techniques is associated with substantial false- positive rates that could lead to unnecessary surgery. A review of epi demiologic data suggests that familial ovarian cancer kindreds are rar e, but women with first-degree relatives who have had ovarian cancer h ave a significant risk themselves for developing ovarian cancer. In ad dition, women with a great number of ovulatory cycles are at an increa sed risk for the disease. Circulating tumor markers are frequently ele vated in women with advanced ovarian cancer, but their value in early detection of ovarian cancer has yet to be established. Advances in end ovaginal ultrasound and color Doppler flow technology have significant ly improved our ability to assess pelvic organs. This article presents the background, rationale, and structure of the Yale Early Detection Program for ovarian cancer, whose goals are to identify the best techn iques for diagnosing ovarian cancer in an early stage, to determine th e frequency with which such tests should be employed, to assess false- positive results, and to identify women who might benefit from prophyl actic oophorectomies.