gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Screening for ovarian cancer by transvaginal ultrasound and serum CA125 in women with a familial predisposition

Meeting Abstract

  • corresponding author presenting/speaker Kristin Bosse - Universitätsfrauenklinik, Köln, Deutschland
  • Kerstin Rhiem - Universitätsfrauenklinik, Köln
  • Martin Madeja - Universitätsfrauenklinik, Köln
  • Peter Mallmann - Universitätsfrauenklinik, Köln
  • Barbara Wappenschmidt - Universitätsfrauenklinik, Köln
  • Rita Schmutzler - Universitätsfrauenklinik, Köln

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocOP518

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Bosse et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: BRCA1/2 mutations go along with a significantly elevated lifetime risk for ovarian cancer reaching up to 20% and 50% for BRCA1 and BRCA2, respectively. The benefit of transvaginal ultrasound (TVUS) in combination with CA125 for the early detection of ovarian cancer in women at risk is still debatable.

Patients: Our data were collected in a prospective study of women who are currently participating in a breast and ovarian cancer screening programme supported by the German Cancer Aid. We report on 680 women with a median age of 41 years (range 30 to 69 years) who had been examined between 1997 and 2004. 89 probands were tested positive for a mutation in the BRCA1/2 gene, 46 carried an unclassified variant and 287 had no identified mutation although they either had experienced breast cancer or a strong familial background. The remaining 258 patients did not undergo testing because no index patient was alive or the patients refused genetic testing. Screening procedures included TVUS with simultaneous measurement of CA125 that were repeated every six months.

Results: Women underwent in average 3.5 semi-annual screening rounds. Total screening rounds comprised 2297 examinations. Of these, 269 exams were performed in mutation carriers, 1234 in women from high risk families and 794 in women from families at moderate risk. Screening for CA125 had been abnormal at least once in 36 patients. TVUS revealed complex cystic lesions in 100 women that persisted after two control examinations in only two women. Altogether eight women underwent a diagnostic laparoscopy because of persistently elevated CA125 (n=3), a suspicious ovarian cyst (n=2) or both (n=3) and revealed an endometriosis in two cases. Two women underwent direct laparotomy. One of them aged 42 presented with a slightly elevated Ca125 level (42 U/ml) and a highly suspicious ovarian cyst that turned out to be a serous cystadenocarcinoma stage Ic. In the second woman aged 43 a ruptured ovarian cyst was diagnosed.

Discussion: Due to the low incidence rate of ovarian cancer in the study cohort the PPV for both screening modalities, TVUS and CA125, was low (8,3% and 1%, respectively). Therefore, ovarian cancer screening by CA125 and TVUS should start at the age of 40 when ovarian cancer risk gets more relevant in mutation carriers. When family planning is completed prophylactic surgery is even more effective and should be discussed with the patient.