Specificity: HE4 versus CA 125
Many women who have benign gynecologic disease have an elevated concentration of circulating CA 125—in fact, as many as 50% of women who have advanced endometriosis.3 In contrast to what is seen when CA 125 is measured, the HE4 level is, typically, within the normal range in women who have endometriosis: In one study, the mean level of HE4 was 41 pM in healthy control women and 46 pM in women who had ovarian endometriosis.2 Contrast that with the mean CA-125 level in the same groups of subjects: 9 U/mL in healthy controls and 44 U/mL in women who had ovarian endometriosis.
Other studies have also reported a low rate of HE4 elevation in women who have benign gynecologic disease. In one study, only 7% of 347 women who had benign gynecologic disease also had an elevated level of HE4.
HE4 helps plan the care of women with a pelvic mass
Of approximately 300,000 women who are hospitalized annually because of an ovarian cyst or a pelvic mass, fewer than 10% are given a diagnosis of invasive ovarian cancer. Many authorities believe that a woman who has ovarian cancer has a greater chance of being cured of her disease if she receives initial, and then subsequent, treatment from a trained gynecologic oncologist at a high-volume center.4
A major challenge for us is to accurately identify, before initial surgery, those women whose pelvic mass or ovarian cyst is most likely to be ovarian cancer. Proper identification would permit us, appropriately, to refer them to a specialty center.
Measuring HE4 and CA 125 in combination may represent a significant advance in our ability to accurately identify and triage patients who are at high risk of serous and papillary ovarian cancer. In one study of postmenopausal women who had a pelvic mass,5 tandem measurement of HE4 and CA 125 resulted in:
- preoperative identification of 93% of women who had ovarian cancer or a tumor of low malignant potential
- misidentification (false-positive result) of high risk of ovarian cancer in only 25% of women whose pelvic mass was, in fact, benign.
Consider taking this step forward now
If you haven’t measured HE4 in your patients who have a pelvic mass or a complex ovarian cyst, consider evaluating the utility of this assay in your practice. There’s good reason to do so: HE4 is the first new marker for ovarian cancer that has been made available to us in 25 years.