A new study published in the JAMA Network Open reveals that Black women are less likely to have elevated levels of cancer antigen 125 (CA-125) at the time of ovarian cancer diagnosis compared to white women. This disparity may lead to underdiagnosis and delayed treatment for Black patients.
The study, which analyzed data from the National Cancer Database, found that Black patients were 23 percent less likely to have elevated CA-125 levels at diagnosis. This disparity was observed even after adjusting for factors such as stage of cancer, comorbidities, and menopausal status.
“We may be further contributing to disparities in referral, disparities in treatment, and ultimately we may be contributing to the lower survival in Black women with ovarian cancer,” lead author Anna Jo Smith, MD, an assistant professor of gynecologic oncology at the University of Pennsylvania, told The Associated Press.
Significance of Cancer Antigen 125 (CA-125) Levels in Ovarian Cancer
CA-125 is a biomarker used in the diagnosis and management of ovarian cancer. Elevated levels of CA-125 are often used to guide decisions about which patients with pelvic masses should be referred to gynecologic oncologists for further evaluation and treatment. However, the current threshold for elevated CA-125 levels was developed from studies on predominantly White populations. The new research indicates that using the same threshold for Black women may result in missed or delayed diagnoses.
Implications for Clinical Practice
The findings of this study have important implications for clinical practice. Healthcare providers should be aware that Black women with ovarian cancer may present with lower CA-125 levels than White women. Relying solely on the standard CA-125 threshold may lead to a failure to recognize the possibility of ovarian cancer in Black patients, potentially delaying necessary treatment.
The authors of the study suggest that new, more inclusive CA-125 thresholds and diagnostic guidelines need to be developed to ensure that all women receive timely and accurate diagnoses, regardless of their race or ethnicity.
Factors Contributing to Racial Disparities
The study also found that Black patients with false-negative CA-125 findings experienced a delay in chemotherapy initiation compared to patients with elevated CA-125 levels. This delay in treatment could contribute to poorer outcomes for Black women with ovarian cancer.
Several factors may contribute to the racial disparities observed in this study. One potential factor is benign ethnic neutropenia, a condition more common in individuals of African descent, which is associated with lower neutrophil counts. Since CA-125 levels are correlated with neutrophil count, this may explain why Black women are more likely to have lower CA-125 levels.
“New thresholds for referral will ensure that all patients get in for rapid care when ovarian cancer is suspected,” Smith said.
Shannon Westin, MD, of MD Anderson Cancer Center in Texas, who was not part of the study, said this study illustrates why it’s important to study how medical tests work in different racial and ethnic groups. “This is a perfect example of work that absolutely needed to be stratified based on race and ethnicity,” Westin said.
Need for Further Research
The authors call for more research to develop inclusive CA-125 thresholds and diagnostic guidelines that are valid across diverse populations. They also suggest that previous studies on ovarian cancer screening using CA-125 levels could be reanalyzed to determine if lower CA-125 thresholds would improve sensitivity and lead to earlier diagnoses.
In conclusion, this study highlights the racial disparities in CA-125 levels at the time of ovarian cancer diagnosis. The findings underscore the importance of considering race and ethnicity in the diagnosis and management of ovarian cancer and the need for further research to develop more inclusive diagnostic approaches.