In a finding that is likely to shake up medical practice, researchers reported here that early detection of a relapse of ovarian cancer with a widely used blood test does not help women live longer. The finding goes against the common presumption that early detection and treatment of cancer is better. It could force doctors and patients to re-evaluate the need for the periodic testing that has become an anxiety-inducing but also reassuring ritual for many women who have had ovarian cancer. Most women who are in remission from ovarian cancer take the test, which measures levels of a protein called CA125, every three months or more frequently. The test can detect the recurrence of the cancer months before symptoms appear, allowing patients to start chemotherapy earlier. But the new study, presented at the annual meeting here of the American Society of Clinical Oncology, found that women who started chemotherapy early based on a test result did not live longer than women who waited until symptoms appeared. “For the first time, women can be reassured that there’s no benefit to early detection of relapse from routine CA125 testing,” said Dr. Gordon J. S. Rustin, director of medical oncology at Mount Vernon Hospital in Middlesex, England, and the lead author of the study. He said women could safely forgo such testing. The finding is another in a series suggesting that early detection of cancer might not always lead to better outcomes for patients. A study published in March, for instance, suggested that early detection of prostate cancer using the PSA blood test did not help men live longer but did lead to unnecessary treatments. This new study does not refer to initial diagnosis of ovarian cancer, only to a relapse. Doctors are convinced that if the initial diagnosis can be made early, which is very difficult, the cancer can be treated by surgery. But for relapsed ovarian cancer, surgery is usually not an option. Dr. Beth Karlan, director of gynecologic oncology at Cedars Sinai Medical Center in Los Angeles, said the results of the new trial would “make us all rethink the approach to treating patients with recurrent ovarian cancer.” Dr. Karlan, who was not involved in the study but presented a commentary on it, said CA125 testing should be done less frequently. But she stopped short of saying it should be eliminated, saying that in any event, patients would not accept that. “Many women often say they live from one CA125 to the next,” she said. The new study, done in Britain and nine other countries, compared 265 women who began chemotherapy after their CA125 levels began to rise with 264 women who waited to begin chemotherapy until they had symptoms, like abdominal bloating or pain. The group getting the test began chemotherapy a median of about five months earlier. But the overall median survival for the groups was the same, about 41 months from the start of their remission. Moreover, the extra chemotherapy seemed to worsen the quality of life. Dr. Rustin said the explanation for the counterintuitive results was not that CA125 was a poor predictor of cancer’s return. Rather, he said, some cancers were sensitive to chemotherapy, so it did not matter if they were treated early. Other tumors were resistant to chemotherapy and would not respond to treatment no matter when it was given. Dr. Andrew Berchuck, director of gynecologic oncology at Duke University, said that while “it’s the American way, sort of, to be aggressive” and treat early, some doctors and patients even now did not start chemotherapy when CA125 rises. “I’ve had patients who wouldn’t dream of not being treated,” Dr. Berchuck said. “But there are also people who wouldn’t want to go back on chemo unless they absolutely have to.” Diane Paul, an ovarian cancer survivor and patient advocate in Brooklyn, said that when she was getting the CA125 test, she asked her doctors not to tell her the results, to reduce her anxiety. “I was in a constant state of agitation, waiting for the test, waiting for the results,” she said. But others would prefer to know. “This makes me feel in control of this disease,” said Carol Tawney of Shawnee, Kan., a seven-year survivor who has her CA125 tested every two months. Source: NY Times