EVALUATING CA-125 FOR OVARIAN CANCER DETECTION: A REVIEW OF DIAGNOSTIC PERFORMANCE

Аннотация

Background: Ovarian cancer remains one of the deadliest gynaecologic malignancies dueto its late-stage diagnosis and thelack ofeffective early screening methods. CA-125, a serum biomarker, has long been used in clinical practice, but its diagnostic accuracy continues to be debated. Objective: This review aims to evaluate the diagnostic performance of CA-125 in detecting ovarian cancer across different clinical settings, with attention to variations based on age, ethnicity, and care context. Methods: A structured literature review was conducted using PubMed, Scopus, and Google Scholar, covering studies published between 1988 and 2025. From an initial pool of 12 studies, 6 were included based on relevance, methodological rigor, and availability of quantitative diagnostic data. Metrics such as sensitivity, specificity, PPV, NPV, and AUC were extracted and compared.Results:CA-125 demonstrated variable diagnostic performance. Sensitivity ranged from 50% to over 90%, while specificity was generally higher in hospital-based settings. One Indonesian study reported an overall accuracy of 94.5% using a 36.5 U/ml cutoff. Ethnicity affected CA-125’s predictive value, with lower PPVs observed in Asian and Black women. Longitudinal evidence showed that elevated CA-125 levels can precede clinical diagnosis by several years. However, algorithmic models like ROMA showed only marginal improvement over CA-125 alone. Conclusion: While CA-125 is a useful diagnostic tool—especially in secondary care—its limitations in primary care and across diverse populations highlight the need for context-specific interpretation. Integration with imaging, risk algorithms, and emerging biomarkers may enhance early detection and reduce falsepositives in ovarian cancer diagnostics. Keywords: Ovarian cancer, CA-125, tumor marker, diagnostic accuracy, sensitivity, specificity, primary care. Introduction:- Ovarian cancer remains a major global health challenge and is currently the seventh most commonly diagnosed cancer and the eighth leading cause of cancer-related deaths among women (World Health Organization [WHO], 2023).It is often diagnosed at an advanced stage due to the asymptomatic nature of early disease and the lack of effective, widely applicable screening tools, resulting in apoor prognosis for many women (Reid et al., 2021). The five-year survival rate drops dramatically from over 90% for stage I to less than 30% for stage III or IV disease (Siegel et al., 2023).Among the biomarkers studied for the early detection of ovarian cancer, cancer antigen 125 (CA-125) remains one of the most widely used and investigated. First introduced by Bast et al. (1983), CA-125 is a high- molecular-weight glycoprotein expressed by coelomic epithelial tissues including the endometrium, fallopian tubes, and peritoneum. Elevated CA-125 levels are present in approximately 80% of women with advanced epithelial ovarian cancer, but its sensitivity in early-stage disease is significantly lower—often below 50% (Zurawski et al., 1988; Jacobs et al., 1996). Furthermore, the biomarker lacks specificity due to its elevation in numerous 98,7:ROTCAFTCAPMI.SECNEICSLACIDEM ,5202 ,lirpA,5emuloV gro.srehsilbupcimedaca.www benign conditions such as endometriosis, menstruation, pelvic inflammatory disease, and even non-gynecologic disorders like liver disease (Funston et al., 2020; Van Gorp et al., 2011). Despite these limitations, CA-125 continues to be a cornerstone in the clinical evaluation of women with pelvic masses or symptoms suggestive of ovarian malignancy. In the United Kingdom, NICE guidelines recommend CA-125 as a first-line test in primary care, particularly for women presenting with persistent bloating, pelvic pain, or other non- specific symptoms (Barlow et al., 2025). In secondary care, CA-125 is used in risk assessment models, such as the Risk of Malignancy Index (RMI) and the Risk of Ovarian Malignancy Algorithm (ROMA), often combined with ultrasound findings and menopausal status to stratify cancer risk (Van Gorp et al., 2011). In recent years, researchers have examined how factors like age, menopausal status, and ethnicity influence CA-125’s diagnostic accuracy. For instance, Funston et al. (2020) demonstrated that age-adjusted CA- 125 thresholds could more accurately estimate cancer risk, while Barlow et al. (2025) reported that predictive values were lower among Asian and Black women compared to their White counterparts, raising concerns about equity in diagnostic evaluation. Given the variability in CA-125 performance across different settings and populations, there remains significant debate regarding its optimal clinical application, particularly in low-prevalence contexts such as primary care. This review aims to systematically assess the diagnostic accuracy of CA-125 across diverse populations and care settings, with the goal of informing moreprecise, equitable, andevidence-based decision-making in ovarian cancer diagnosis. Methodology:-This review