Ovarian cancer accounts for about 3% of cancers among women, but it causes more deaths than any other cancer of the female reproductive system. In an analysis of samples collected by Metropolis Healthcare in the previous year, reveals that 27.9% women in the pre-menopause and 40% women in the post-menopause where tested positive for high levels out of the 521 samples processed at Metropolis Healthcare in India.
The Risk of Ovarian Malignancy Algorithm (ROMA) can be used as a supplement to the standard pre surgical evaluation to further assess the likelihood of malignancy before surgery when the presurgical evaluation does not indicate malignancy. It combines the results of Human Epididymis Protein 4 (HE4), CA 125, and menopausal status to generate a single numerical score that correlates with the likelihood of malignancy being seen at surgery.
The CA 125 test in itself isn’t accurate enough to use for ovarian cancer screening in all women because many noncancerous conditions can increase the CA 125 level and hence the ROMA Index test is recommended for further course of action. The ROMA test is intended for use in women who are over 18 years of age and should not be used in women who have a rheumatoid factor concentration >250 IU/mL. This is a highly specialized test therefore the sample size in the data below is small.
In an analysis of data in the previous year, Metropolis Healthcare has analysed the risk of ovarian cancer in India.
| Count of Reference | Column Labels | |||
| Row Labels | Between 7.4 – 25.3 | Less than 7.4 | more than 25.3 | Grand Total |
| 2 | 18 | 2 | 22 | |
| (Pre Menopause)
10 to 20 |
||||
| 20 t0 30 | 32 | 109 | 6 | 147 |
| 30 to 40 | 56 | 146 | 8 | 210 |
| Total | 90 | 273 | 16 | 379 |
| 45 | 18 | 34 | 97 | |
| (Post Menopause) | ||||
| 60 to 70 | ||||
| 70 to 80 | 13 | 2 | 20 | 35 |
| above 80 | 6 | 4 | 10 | |
| 64 | 20 | 58 | 142 | |
| Grand Total | 154 | 293 | 74 | 521 |
 *Premenopausal> or = 7.4 : High risk < 7.4 : Low risk *Postmenopausal> or = 25.3 : High risk < 25.3 : Low risk
Findings:
- Pre –menopause : 2nd reading (Positively affected sample size = Columns considered – Between 7.4 – 25.3 + More than 25.3 Considered age group between 10-40 years, out of 379 sample tested 90 (2+32+56) + 16 (2+6+8)= 106 samples are observed to be positive i.e. In Per menopause woman’s 27.9% found positively affected.
- Post – menopause
Age group between 60- 80 and above years, out of 142 samples tested 58 (34+20+4) samples are observed to be positive. i.e. In post menopause women’s 40% found positively affected.
Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss. The most common symptoms include: bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often). Someone who has maternal history, evidence of ovarian cancer in family especially blood relations need to undergo test and also some time there are no symptoms visible as mentioned above.
A small portion of ovarian cancers occur in women with inherited gene mutations linked to an increased risk of ovarian cancer. These include mutations in the BRCA1 and BRCA2 genes. Most ovarian cancers have several acquired gene mutations. Research has suggested that tests to identify acquired changes of certain genes in ovarian cancers, like the TP53 tumor suppressor gene or the HER2 oncogene, can help predict a woman’s prognosis.
Commenting on the study, Dr. Sonali Kolte, General Manager, Medico Marketing, said, “Awareness needs to be generated amongst women which will aid in detecting the disease in its early stages, so that the treatment can be started immediately. Family history of epithelial cancers is specially associated with increased risk of ovarian cancer. There are genetic markers, which can predict whether such an individual is at an increased risk of developing ovarian cancer. The most studied gene associated with ovarian cancer is the BRCA1 gene. If relatives of patients or even blood relations who develop ovarian cancer are found to have this gene, they should undergo frequent surveillance for development of ovarian cancer. The most lethal form of gynaecological cancer, is potentially curable if diagnosed early and treated by surgeons familiar with the management of ovarian cancer. However, the symptoms of ovarian cancer are related to the presence of adnexal masses and are often vague and unspecific.â€
ROMA increases the diagnostic value of the dual marker combination HE4 and CA 125. Measured values of HE4 and CA 125 can be combined in an algorithm called ROMA. This algorithm includes additionally the menopausal status. Several published studies show that ROMA helps in the triage of pre- and postmenopausal women suspected for ovarian cancer. This high accuracy helps to stratify the women into low- and high-risk groups and thus may contribute to better diagnosis, treatment and outcome.
(Source: Indian Journal of Cancer, American Cancer Society)
