About 21 women are diagnosed with ovarian cancer every day in the UK, making it the sixth most common form of cancer in women.

To diagnose ovarian cancer, a blood test is used to measure the amount of a protein called CA125 in the body. High levels of this protein can be a sign of cancer, but it isn’t always accurate – high amounts of CA125 in the blood can be caused by menstruation, pregnancy and conditions like uterine fibroids and endometriosis.

Other cases may be missed when levels of CA125 are too low, delaying diagnosis until the disease is more advanced.

Now, thanks to research funded by Wellbeing of Women, a new type of blood test has been shown to detect ovarian cancer more accurately than the current CA125 test, especially in women under the age of 50.

Excitingly, Dr Garth Funston, a GP and Clinical Senior Lecturer in Primary Care Cancer Research at the Wolfson Institute of Population Health at Queen Mary University of London, has shown that this test is reliable in a primary care setting.

The research, which was funded when Dr Funston was based at the University of Manchester, means GPs might be able to use the test in the future to help identify which women should be referred to hospital for further tests, ensuring faster diagnoses and potentially at an earlier stage,

The problem with diagnosing ovarian cancer

In the UK, women with suspected ovarian cancer will typically have a blood test to measure levels of CA125. This test can either be done at a GP surgery or hospital.

Women are also likely to be given an ultrasound scan, which is typically transvaginal (when a small device is inserted into a woman’s vagina).

Women with raised levels of CA125 go on to have further tests and procedures. These may include

• a CT scan, which uses X-rays and a computer to create detailed images of the inside of the body
• a biopsy to remove a small sample of cells or fluid from the ovaries
• a laparoscopy (where a doctor examines the ovaries using a small camera on the end of a tube, which is inserted through a small cut in the stomach)
• surgery to remove ovarian tissue.

However, nine in 10 women with high amounts of CA125 in their blood will not have ovarian cancer. This means they are subjected to unnecessary and invasive tests.

Meanwhile, some women with ovarian cancer may have low levels of CA125. These can be missed by the current CA125 test, which means their disease is likely to be diagnosed only after it is more advanced and harder to treat.

A new GP blood test to speed up diagnosis and treatment

Dr Funston and his team at the University of Manchester focused on analysing levels of a protein in the body called HE4 alongside CA125 with the aim of understanding if this could be a more reliable method of detecting ovarian cancer.

The potential to use HE4 as an indicator of ovarian cancer has previously been studied in hospital settings, but Dr Funston’s research is the first to study this within primary care.

Researchers examined blood samples collected from 1,247 patients over a 12-month period. These were tested for HE4, and the team investigated the diagnostic accuracy of HE4 alone and in combination with CA125.

They discovered that both HE4 and CA125 worked well in detecting ovarian cancer, but both tests had their limitations. Researchers found that using a single cut-off figure for HE4 levels in determining potential ovarian cancer cases did not make the test any more effective than the current CA125 test.

However, researchers noted that levels of HE4 increase with age. Using an existing algorithm – ROMA – Dr Funston and his team were able to show that HE4 levels, when analysed alongside the current CA125 test and within this algorithm, could improve the detection of ovarian cancer, particularly in women under the age of 50.

Dr Funston says:

“The promise of a new blood test to diagnose ovarian cancer more accurately is exciting. Ovarian cancer is notoriously difficult to diagnose at an early stage, but we know that the earlier a woman starts her treatment, the more likely it is to be successful, so it’s important we are continually searching for better and faster ways to detect the disease."

“This is particularly significant for women who are under the age of 50 as the current blood test for CA125 is notoriously less accurate in younger women.

“Our research provides a real opportunity to improve diagnosis, enabling women to receive treatment sooner and hopefully improve patient outcomes. We now need larger studies to evaluate the test on more women.”

This project saw Dr Funston awarded the inaugural Transformational Research Award from The World Ovarian Cancer Coalition in 2021.

Making this new test a widely used reality

This is a significant step forward in our ongoing mission to save and change the lives of women and girls.

The next step is to confirm the reliability of the age-adjusted algorithm in a much larger study. This is required before a clinical recommendation about the routine use of this HE4 blood test can be made for primary care.

Read our news story on this new GP blood test that could help diagnose ovarian cancer faster and more accurately.

Wellbeing of Women is funding several research projects to help improve treatment and care for women with gynaecological cancer. Other studies focusing on ovarian cancer include:

• Dr David Jeevan investigating a potential new test for a rare type of ovarian cancer
• Dr Sarah McClelland work to prevent chemotherapy resistance in ovarian cancer
• Prof Jayson’s research to predict the effectiveness of Avastin (bevacizumab) in ovarian cancer
• The PARP-inhibitor Study (PAIRS) to investigate if resistance to PARP inhibitors can be overcome in advanced ovarian cancers. This is funded in partnership with Artios Pharma Limited.