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June 23, 1993

CA-125 as a Screening Test for Ovarian Cancer

JAMA. 1993;269(24):3106. doi:10.1001/jama.1993.03500240050018

To the Editor.  —The study by Helzlsouer et al1 concludes that CA-125 levels are not sensitive enough to screen for ovarian cancer. We believe that this test is an effective screening tool if used correctly.In their study, Helzlsouer et al1 used a single CA-125 determination from 1974 as an indicator of cancer incidence for the next 14 years. They used 35 U/mL as the level predictive of probable ovarian cancer. Two problems in experimental design critically weaken their conclusions.First, screening with CA-125 or any other test is not done once every 14 years. With only a single CA-125 determination measured as many as 14 years before the woman developed ovarian cancer, it is not surprising that significant numbers of women with cancer had CA-125 levels that were normal. The test preceded the cancer by too many years. Using an upper normal limit of 30 U/mL and