A year ago my mom died from ovarian cancer after a five-year battle. Upon her diagnosis, her cancer doctor suggested that her daughters get a CA-125 test routinely. My GYN refuses to do this test or the vaginal ultrasound because she says this is not proper protocol, and that I have no weapons in protecting myself against this dreaded disease. Is this true? I am interested in an ovarian cancer research project that I've read about, but have been unable to find information on how to participate. Can you help?

--H.B.

CA-125 is a blood factor that MIGHT be elevated in SOME cases of ovarian cancer; it may also be high in such benign conditions as fibroids and endometriosis. This drastically limits the value of CA-125 testing as a screening test, especially in premenopausal women, who are likely to have high results for many reasons. It is more useful in postmenopausal women, in conjunction with a pelvic exam and vaginal ultrasound.

Current recommendations call for women who have two first-degree relatives (mother, daughter, sister) with ovarian cancer to be offered the screening, but not all women with one relative. Ovarian cancer affects 30-50 of every 100,000 women (lifetime incidence of 1 in 70). Having one relative with ovarian cancer raises those odds to 1 in 20. This may sound like a lot, but given the limitations of the available tests, it means that more than 60 women with an abnormal CA-125 or ultrasound would end up undergoing surgery to detect one case of ovarian cancer.

If you are my patient and you request a CA-125 and ultrasound, it is incumbent upon me, as a doctor, to inform you of the limitations of the tests. All test results may be normal and you may still have ovarian cancer, or get it in the future. Or your CA-125 could be elevated and you could undergo surgery only to find there is nothing wrong. Also, insurance may not pay for such screening, or for the surgery that results from it, leaving you with a large bill. If you understand the pros and cons and still insist on the tests, I will order them. Most women, when given all the information, elect not to have the testing, but that is your decision to make, not your doctor's -- it is your doctor's job to give you all the information so you can make a truly informed decision.

You may want to call your local university hospital's cancer center for information on trials regarding ovarian cancer screening. Or, check out the website of the National Cancer Institute.