Experimental OvaPrint Blood Test May Help Detect Ovarian Cancer Early

Key Points

• Ovarian cancer is the deadliest female reproductive cancer, claiming more than 13,000 lives each year in the United States.
• About 93 percent of people who receive early-stage ovarian cancer treatment are alive five years after their diagnosis, compared to about 31 percent of those who are diagnosed later.
• No one knows the cause of ovarian cancer, and since no reliable tools for early detection of ovarian cancer exist, it's usually diagnosed in its advanced stages.

Ovarian cancer, which can occur in the ovaries, fallopian tubes or peritoneum (the lining of the pelvis and abdomen), is the fifth-leading cause of cancer deaths in women. The reason it's so lethal is the lack of effective screening tools. Ovarian cancer is typically diagnosed in the advanced stages when it's more challenging to treat.

A new screening tool, the OvaPrint blood test, could help improve ovarian cancer diagnosis at much earlier stages of the disease.

How is ovarian cancer diagnosed in 2023?

"About 70 percent of ovarian cancer diagnoses occur when the disease is advanced," said Thad R. Denehy, M.D., the director of gynecologic oncology at Cooperman Barnabas Medical Center in Livingston, New Jersey. "Early detection of ovarian cancer could substantially improve survival rates."

For invasive epithelial cancer (IEC)—the most common type of ovarian cancer—the five-year relative survival rate is 93 percent when it's diagnosed in its initial stages, according to the American Cancer Society (ACS). That rate drops to 31 percent when it is diagnosed at an advanced stage.

In the United States, a woman has a 1 in 78 chance of developing ovarian cancer in her lifetime, according to the ACS. The risk of dying from the disease is 1 in 108.

Experts don't know what causes ovarian cancer. Since the risk of developing the disease is so significant, however, the Ovarian Cancer Research Alliance (OCRA) issued a 2023 recommendation that people remove their fallopian tubes if they're done having children and are having pelvic surgery for non-life-threatening reasons.

"Early detection is challenging because the disease is usually asymptomatic in the initial stages," said Alpa Patel, Ph.D., the senior vice president of population science at the ACS in Atlanta.

Symptoms that do appear—two of the common ones are frequent urination and abdominal pain—are relatively vague. The disease is frequently misdiagnosed for other conditions, such as urinary tract infections, uterine fibroids or irritable bowel syndrome, and is only correctly identified when issues get worse.

"When it comes to how to test for ovarian cancer, there's currently no way to screen for early-stage disease as there is for breast, cervical or colon cancer," Patel said.

"Occasionally, detecting an enlarged ovary through a medical examination may be helpful, but the lack of a definitive screening method remains a challenge," Denehy said. "The problem is there's no mammogram for the ovary."

A doctor may detect a tumor through a pelvic exam, though this can be formidable since the affected areas are so deep within the abdomen. This is followed by imaging—such as a transvaginal ultrasound and CT scan—and other tests.

There is no ovarian cancer blood test to screen for the disease effectively. The CA-125 blood test can detect levels of proteins that are often elevated when ovarian cancer is present. However, people with benign conditions can also have heightened levels of these proteins.

The OVA 1 test also measures protein levels and is a risk-stratification tool that may alert doctors to potential malignancies. Ultimately, a gynecologic oncologist must perform surgery to remove the mass and perform a biopsy.

"Traditional biopsies are generally avoided for a few key reasons," Denehy said. "First, if the mass is malignant, attempting a biopsy may risk rupturing an intact ovarian mass, potentially causing the cancer to spread throughout the abdomen. Second, the abdomen lacks easy access points, unlike areas such as the cervix, which can be easily reached for biopsies. Attempting to aspirate fluid from an ovarian cyst may also yield false-negative results."

Because of the risks involved, surgery and biopsies are typically performed only when there's evidence of advanced disease. Specifically, that's when the cancer has spread beyond the ovaries and presents as lesions, fluid accumulation or lumps in other parts of the body.

The OvaPrint test would potentially allow doctors to determine whether a mass is benign or malignant before surgery, researchers wrote in a 2023 study published in the journal Clinical Cancer Research. The test could help detect cancer before it spreads.

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How does the OvaPrint test work?

The OvaPrint test uses a cell-free DNA methylation liquid biopsy approach to search for cancer cells that have broken away from the tumor and circulated in the blood. The biopsy's name indicates how the cells are free from their original cells and contain DNA mutations distinct from those in the tumor.

OvaPrint could also be used to detect various types of early-stage cancers, according to an October 2023 press release.

Researchers designed the test specifically to identify high-grade serous ovarian carcinoma (HGSOC) because it's the most lethal and prevalent type of ovarian cancer. Other subtypes of ovarian cancer are likely to require different markers, according to the study authors.

For the study, researchers collected 372 samples from patients who had ovarian cancer and others with normal ovaries or benign tumors.

They found the test was highly sensitive—with a low rate of false-negative results—and highly specific, with a low rate of false positives. The test distinguished between benign and cancerous masses with 91 percent accuracy.

"Cell-free DNA-based tests for cancer detection are a promising area of scientific advancement, but we still have a lot to learn. In this study, they used samples from women with known ovarian cancer and women with benign ovarian masses," Patel said. "This test performed well in these retrospective samples, which is an important first step, but we still need to learn about how the test would perform in women who may not have any symptoms in a prospective study. This is definitely an exciting study to build upon."

Denehy agreed that it is a "very exciting" development, noting any new information on ovarian cancer diagnoses is welcome.

"Early diagnosis is critical, as most women currently present with late-stage disease, which is more challenging to treat," he said. "This blood test is a positive step towards improving cure rates."

How to check for ovarian cancer at home

"There's no way to screen for ovarian cancer at home," Patel said.

She recommended alerting your doctor to any changes in your health, especially if you have one or more ovarian cancer risk factors, which may include, but aren't limited to, the following:

• Carrying genes associated with hereditary nonpolyposis colorectal cancer, HNPCC or Lynch syndrome
• Carrying the breast cancer gene BRCA1 or BRCA2
• Having endometriosis
• Having a family history of ovarian cancer
• Being older
• Being postmenopausal

Ovarian cancer symptoms may include:

• Back pain
• Bloating
• Changes to your period
• Dyspepsia
• Fatigue
• Pelvic pain
• Persistent feeling of fullness
• Trouble eating
• Urgency or increased urination

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Can a Pap smear detect ovarian cancer?

The Pap test involves collecting cells from the cervix and examining them in a lab for abnormalities that could signal cervical cancer or a heightened risk of the disease.

However, very rarely do ovarian cancer cells travel to the cervix where they might be detected in a Pap test, according to Mayo Clinic. Because the chance of detection is exceedingly rare, the Pap test isn't considered a reliable screening method.

The bottom line

Ovarian cancer is the deadliest female reproductive cancer, claiming more than 13,000 lives each year in the U.S., according to the American Cancer Society.

"Recently, many treatment advancements, such as targeted cancer drugs, have extended affected women's lives, and potential new screening tools like the OvaPrint test are promising developments," Denehy said. "Prevention is crucial."

Lifestyle factors—diet, obesity and cigarette smoking—may also affect one's risk of ovarian cancer, a 2008 report suggested. Exposure to herbicides and pesticides has been linked to ovarian cancer, as has household talcum powder.

"There are promising advancements in the diagnosis and treatment of ovarian cancer, but it is important to remember for overall cancer prevention, follow recommended cancer screening guidelines, don't smoke, maintain a healthy body weight, be physically active, avoid alcohol, and eat a diet rich in fruits and vegetables," Patel said.