title: Use of CA-125 Tests and Computed Tomographic Scans for Surveillance in Ovarian Cancer.
abstract: OBJECTIVE
  A 2009 randomized clinical trial demonstrated that using cancer antigen 125 (CA-125) tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patients' quality of life without improving survival, compared with clinical observation. The Society of Gynecologic Oncology guidelines categorize CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance. To date, few studies have examined the use of CA-125 tests in clinical practice.
  
  
  OBJECTIVE
  To examine the use of CA-125 tests and computed tomographic (CT) scans in clinical practice before and after the 2009 randomized clinical trial and to estimate the economic effect of surveillance testing.
  
  
  METHODS
  A prospective cohort of 1241 women with ovarian cancer in clinical remission after completion of primary cytoreductive surgery and chemotherapy at 6 National Cancer Institute-designated cancer centers between January 1, 2004, and December 31, 2011, was followed up through December 31, 2012, to study the use of CA-125 tests and CT scans before and after 2009. Data analysis was conducted from April 9, 2014, to March 28, 2016.
  
  
  METHODS
  The use of CA-125 tests and CT scans before and after 2009. Secondary outcomes included the time from CA-125 markers doubling to retreatment among women who experienced a rise in CA-125 markers before and after 2009, and the costs associated with surveillance testing using 2015 Medicare reimbursement rates.
  
  
  RESULTS
  Among 1241 women (mean [SD] age 59 [12] years; 1112 white [89.6%]), the use of CA-125 testing and CT scans was similar during the study period. During 12 months of surveillance, the cumulative incidence of patients undergoing 3 or more CA-125 tests was 86% in 2004-2009 vs 91% in 2010-2012 (P = .95), and the cumulative incidence of patients undergoing more than 1 CT scan was 81% in 2004-2009 vs 78% in 2010-2012 (P = .50). Among women whose CA-125 markers doubled (n = 511), there was no significant difference in the time to retreatment with chemotherapy before and after 2009 (median, 2.8 vs 3.5 months; P = .40). During a 12-month period, there was a mean of 4.6 CA-125 tests and 1.7 CT scans performed per patient, resulting in a US population surveillance cost estimate of $1 999 029 per year for CA-125 tests alone and $16 194 647 per year with CT scans added.
  
  
  CONCLUSIONS
  CA-125 tests and CT scans are still routinely used for surveillance testing in patients with ovarian cancer, although their benefit has not been proven and their use may have significant implications for patients' quality of life as well as costs.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Esselen
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bixel
authors.affiliation: US Oncology Research and Arizona Oncology, Tucson.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Burger
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cristea
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor8Division of Hematology and Oncology, Department of Health Management and Policy, University of Michigan Comprehensive Cancer Center, Ann Arbor.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.affiliation: Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Levenback
authors.affiliation: Division of Gynecologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Gina
authors.initials: G
authors.lastname: Mantia-Smaldone
authors.affiliation: Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ursula A
authors.initials: UA
authors.lastname: Matulonis
authors.affiliation: Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.affiliation: Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sun
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus.
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
mesh_terms: D018394:CA-125 Antigen / Q000097:blood*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D011788:Quality of Life; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018394:CA-125 Antigen