Ultrasound assessment of ovarian cancer risk in postmenopausal women with CA125 elevation

We have previously shown that, in asymptomatic post-menopausal women, serum CA125 elevation is associated with a 36-fold increase in risk of ovarian c ancer. This study was undertaken to assess the value of pelvic ultrasound f or further stratification of ovarian cancer risk. Of 22 000 post-menopausal women, aged greater than or equal to 45 participating in an Ovarian Cancer Screening Trial, 741 with a CA125 greater than or equal to 30 U ml(-1) und erwent pelvic ultrasonography. Twenty index cancers (primary invasive epith elial carcinomas of the ovary and fallopian tube) were diagnosed amongst th ese 741 women during a median follow-up of 6.8 years; Ultrasound results se parated the women with CA125 elevation into two groups. Those with normal o varian morphology had a cumulative risk (CR) of index cancer of 0.15% (95% confidence interval (CI) 0.02-1.12) which is similar to that of the entire population of 22 000 women (0.22%, 95% Cr 0.18-0.30). In contrast, women wi th abnormal ovarian morphology had a CR of 24% (15-37) and a significantly increased relative risk (RR) of 327 (156-683). Ultrasound can effectively s eparate post-menopausal women with raised CA125 levels into those with norm al Scan findings who are not at increased risk of index cancer and those wi th abnormal findings who are at substantially increased risk of index cance r.