title: Strategies for improving the specificity of screening for ovarian cancer with tumor-associated antigens CA 125, CA 15-3, and TAG 72.3.
abstract: OBJECTIVE
  To assess different strategies for improving the specificity of screening for ovarian cancer with tumor-associated antigens, including concomitant measurement of multiple tumor markers and serial measurement of CA 125.
  
  
  METHODS
  A combination of CA 125, CA 15-3, and TAG 72.3 was evaluated in serum samples from 217 of 1010 apparently healthy postmenopausal women who had participated in a study of screening for ovarian cancer and who had a serum CA 125 level of 20 U/mL or greater. In addition, serial serum CA 125 levels were determined in 30 women with an initially elevated CA 125 level (30 U/mL or more) and 30 women with a CA 125 level less than 30 U/mL.
  
  
  RESULTS
  The specificity of CA 125 at upper limits of 30 and 50 U/mL was increased from 97.0 and 99.5%, respectively, to 98.9 and 99.9% when a positive test was defined as an elevated serum CA 125 level in combination with either a CA 15-3 greater than 30 U/mL or a TAG 72.3 greater than 10 U/mL. Definition of a positive result as a serum CA 125 level greater than 50 U/mL at the initial test and greater than 30 U/mL at 3-month follow-up achieved a specificity of 99.6%.
  
  
  CONCLUSIONS
  Levels of specificity suitable for screening asymptomatic postmenopausal women can be achieved using tumor-associated antigens measured serially or in combination. Further studies are required to determine the sensitivity of these strategies for preclinical ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cambridge, Rosie Maternity Hospital, United Kingdom.
authors.forename: I J
authors.initials: IJ
authors.lastname: Jacobs
authors.forename: D H
authors.initials: DH
authors.lastname: Oram
authors.forename: R C
authors.initials: RC
authors.lastname: Bast
mesh_terms: D000951:Antigens, Neoplasm / Q000097:blood; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D012680:Sensitivity and Specificity
chemical_list: D000951:Antigens, Neoplasm; D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D006023:Glycoproteins; C047052:tumor-associated antigen 72