By Dr. Mitchell Hecht
Q: Why is the CA-125 blood test not a good screening test for ovarian cancer? I asked my doctor to order the test at my last physical, but he refused. — L.Z., Wilkes Barre, Pa.
A: Unfortunately, there are no commercially available screening tests for detecting early ovarian cancer. The only approved use of the CA-125 blood test is in women with known ovarian cancer to monitor treatment response or recurrence. CA-125 is a protein produced in response to irritation of the surfaces of the body cavities. The CA-125 blood test is neither sensitive enough to pick up an early cancer nor specific enough to be clinically useful as a screening test.
Even in advanced ovarian cancer, the CA-125 level has been normal in 20 percent of cases. Some ovarian cancers do not produce any CA-125. More importantly, only half of all ovarian cancers will cause a rise in the CA-125 while the cancer is still contained within the ovary.
For women of high risk, gynecologists may still order a CA-125 test along with a transvaginal ultrasound at the time of their gynecological exam. Always pay attention to persistent vague abdominal symptoms of bloating that have not been explained by irritable bowel syndrome or constipation. If colonoscopy and X-rays don’t explain your symptoms, be sure your doctor scans your ovaries and abdomen.
Good news: There may be a screening test for ovarian cancer within the next year from Correlogic Systems — the OvaCheck blood test (www.correlogic.com) available through Quest Diagnostics and LabCorp.
Q: My 78 year-old brother has type 2 (adult-onset) diabetes. He’s at least 20 pounds overweight and doesn’t exercise. He claims that he got diabetes from several cortisone shots received many years ago. Is that possible? — H.S., Pikesville, Md.
A: Steroids definitely can cause and worsen diabetes, especially when taken by mouth or by injection for extended periods. But I doubt that a remote history of a few cortisone injections presumably for bursitis or arthritis is the reason why he became a diabetic. The amount and duration of steroid exposure just doesn’t seem sufficient to make him a diabetic.
Steroids can potentially cause diabetes because they’re antagonistic of insulin, the body’s blood sugar-lowering hormone.
The most likely cause of your brother’s diabetes is his gradual weight gain because of a combination of age, less physical activity and increased caloric consumption. Let’s face it — it’s tough to lose weight when arthritis or other illness limits your ability to get around. He should check his thyroid function, since a sluggish thyroid makes weight loss more difficult.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Due to the large volume of mail received, personal replies are not possible.