Back in 2008, Kim Snyder felt as if she had the flu. She coughed all the time and could barely eat. Yet her belly was getting bigger.
"I looked pregnant," said Snyder, now 47. One doctor said it was the fertility treatment she was undergoing. A bad cold, said another. A third told her it was irritable bowel syndrome.
When the Clearwater woman's condition worsened, she went to the emergency room.
"In 15 minutes, they knew what it was, and I had a diagnosis of ovarian cancer," Snyder said. "My gynecologic oncologist said the tumor was the size of a volleyball. If I hadn't kept going to doctors, I could be dead by now."
Despite the size of the tumor, her cancer was only at Stage 1, extraordinarily early to detect ovarian cancer. There is no definitive test for the disease, whose vague symptoms mimic scores of other disorders.
Doctors use a combination of vaginal ultrasound, which looks for growths on the ovaries and in the abdomen, and a blood test known as CA125. It checks for a protein sometimes elevated by ovarian cancer, but also affected by infections and menstruation.
"In early-stage disease, 50 to 60 percent of women have an abnormal CA125," said Dr. Robert Wenham, director of clinical research for gynecologic oncology at Moffitt Cancer Center. "With late-stage ovarian cancer, that number goes up to 80 to 85 percent. But, still, some women who have ovarian cancer won't have an abnormal CA125."
For that reason and others, many authorities, including the National Cancer Institute, recommend against using CA125 for routine screening of ovarian cancer, even though the blood test is relatively inexpensive.
But a new study in the journal Cancer suggests that CA125 — along with ultrasound and carefully evaluating women at high risk — may be the key to early diagnosis. The study followed more than 4,000 postmenopausal women for 11 years. Based on changes in their CA125 levels over time, the women were divided into risk groups. Those at highest risk were tested more frequently and received transvaginal ultrasound to look for tumors. Of all the women in the study, 117 needed ultrasound testing; of those, 10 had surgery. Four women had early-stage ovarian cancer.
"That's one in a thousand who had cancer," said Wenham. As for the other 999, he noted, "you have to consider the impact on women in terms of stress and anxiety during follow-up testing and monitoring, the health risks of testing and the cost associated with all that.'' For some, that impact could even include unnecessary surgery, and abdominal surgery is considered particularly risky.
In several large studies, CA125 and transvaginal ultrasound have not been proven to increase ovarian cancer survival.
But Snyder thinks the risks are worthwhile to save even one life.
"Why can't we just screen women during their annual well-woman exam, as opposed to reacting to a late stage diagnosis?" asked Snyder, who is Tampa Bay president of the ovarian cancer advocacy group Ovacome. She hopes the new study leads to more doctors offering the blood test and more women asking for it.
Even the study's lead author, Dr. Karen Lu at M.D. Anderson Cancer Center in Houston, cautioned that the study should not change medical practices yet. More information is needed, including results from a large British trial due out in 2015.
"I think the (Texas) study is hopeful,'' Wenham said. "Maybe we'll find we're helping patients live longer and not putting undo burden on those who don't have cancer. But I don't think the findings will be practice-changing at this time."
Contact Irene Maher at firstname.lastname@example.org.