Are Urine Biomarkers Ready for Prime Time in Detecting Early Ovarian Cancer?
Posted: Wednesday, April 24, 2019
Although some biomarker testing for detection of ovarian cancer currently exists, it is not well developed, and information provided from these biomarkers has been limited. Barbara-Ann Guinn, PhD, of the University of Hull, United Kingdom, and her colleagues published a review of these urine biomarkers in detecting early ovarian cancer in Biomarkers in Cancer. They conclude that further validation is necessary before they can be considered adequate and reliable.
The only serologic biomarker currently used in the management of patients with ovarian cancer is CA-125. However, CA-125 is a poor biomarker for early-stage ovarian cancer and can be elevated in many other conditions such as endometriosis or ovarian cysts.
Currently, urine biomarkers for ovarian cancer under study include the human epididymis protein 4 (HE4) and B-cell lymphoma 2. “However,” the authors commented, “insufficient sensitivity and specificity readings have so far left the ability to differentiate between malignant and benign debatable, with HE4 having only a specificity of 87% and a sensitivity of 74%.” Additionally, polyamines, protein profiling, microRNAs, and matrix metalloproteinase in the urine have all been studied as potential biomarkers of ovarian cancer but require further validation.
There is currently a movement toward multiple biomarker panels to augment the sensitivity and specificity of single tests. Combinations of HE4 and CA-125 together along with germline screening for BRCA1 and BRCA2 may provide a more accurate diagnosis for high-risk populations. This technique has not been optimized for use in detecting early stages of the disease, however. It is likely that a combination of urine biomarkers, nonurine biomarkers, transvaginal ultrasound, and physical examination will be able to detect stages I and II ovarian cancers.
Disclosure: The study authors reported no conflicts of interest.