CA125 and Ultrasound in Detecting Ovarian Cancer in Postmenopausal Women

United Kingdom Collaborative Trial Of Ovarian Cancer Screening

RATIONALE: Screening tests may help doctors detect ovarian cancer early when the survival is much more encouraging. It is not yet known whether a CA125-based or ultrasound strategy is more effective in detecting ovarian cancer early thereby impacting on the mortality from the disease in postmenopausal women from the general population.

PURPOSE: Randomized clinical trial to assess the impact of screening using a multimodal strategy using CA125 interpreted by the Risk of Ovarian Cancer Algorithm (ROCA) followed by transvaginal ultrasound as a second line test versus transvaginal ultrasound on mortality from the disease in postmenopausal women from the general population.

OBJECTIVES:

• Determine the impact of preclinical detection of ovarian cancer by screening on ovarian cancer mortality in postmenopausal women.
• Determine the physical morbidity of ovarian cancer screening in this population.
• Determine the psychological consequences of screening results (true negative, true positive, false negative, and false positive) in this population.
• Compare the interventions that result from screening for ovarian cancer using CA 125 monitoring and ultrasound in this population.
• Compare the feasibility of population screening, in terms of compliance rates with annual screening for ovarian cancer with these strategies.
• Compare the performance of these screening strategies in this population.

OUTLINE: This is a randomized, multicenter study. Participants are randomized to 1 of 3 screening arms.

• Arm I: Participants do not undergo screening.
• Arm II: Participants undergo screening with an annual CA 125 level interpreted using the Risk of Ovarian Cancer Algorithm (ROCA). Depending on the results of the test, some patients may undergo additional screening.
• Arm III: Participants undergo screening with an annual transvaginal or transabdominal ultrasound. Depending on the results of the test, some patients may undergo additional screening.

Participants in all arms complete a health questionnaire at 3-5 years after study entry and in 2014.

PROJECTED ACCRUAL: A total of 200,000 participants (100,000 for arm I and 50,000 each for arms II and III) will be accrued for this study within 5 years.

DISEASE CHARACTERISTICS:

• Postmenopausal, as defined by meeting 1 of the following criteria:

  • More than 12 months of amenorrhea after natural menopause or hysterectomy
  • Received more than 12 months of hormone replacement therapy for menopausal symptoms

• No prior ovarian malignancy

• No prior bilateral oophorectomy

• Not at high risk for ovarian cancer due to familial predisposition as defined by the UKCCCR Familial Ovarian Cancer Screening Study

PATIENT CHARACTERISTICS:

Age

• 50 to 74

Performance status

• Not specified

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• Not specified

Renal

• Not specified

Other

• No active non-ovarian malignancy

  • Prior malignancy allowed provided there is no documented persistent or recurrent disease and patient has not received treatment for more than 1 year

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• Not specified

Endocrine therapy

• See Disease Characteristics

Radiotherapy

• Not specified

Surgery

• See Disease Characteristics

Other

• No concurrent participation in any other ovarian cancer screening study