Dear Dr. Roach: I don’t know why everybody keeps debating the accuracy of the PSA test. At least it’s a test that shows something. There’s nothing like it for ovarian cancer.

Why is that?


Dear R.R.: There are several analogous tests to the PSA for ovarian cancer, and the most commonly used is called the CA-125. The CA-125, like the PSA (prostate-specific antigen) test, was initially developed and used for monitoring the response to therapy in someone who has cancer.

Both tests are useful for following the course of the disease in patients with known cancer, but are limited by the fact that there are cancers that do not have high levels of these blood markers.

The PSA and the CA-125 have been evaluated for use as screening tests — that is, trying to find disease in someone with no known cancer and no symptoms — but they suffer from a lack of sensitivity and specificity.

They can be normal even in someone who has cancer (that’s sensitivity), and especially they can be abnormal in someone who does not have cancer (specificity).

The PSA remains a hotly debated test for use in screening, but experts recommend against the CA-125 test as a screening test due to its poor specificity.

Several newer tests exist, the best-studied of which is a combination of five different blood tests called the OVA1, which is more sensitive but less specific than the CA-125, and which has not been evaluated as a screening tool.

We need better screening tests for prostate and ovarian cancer. But since ovarian cancer is far deadlier than prostate cancer, finding a better blood test for early detection of ovarian cancer is even more desperately needed.

Dear Dr. Roach: I have ridges on my fingernails that go from the cuticle to the tips of the nails. Is this something to worry about?


Dear A.C.: Ridges in the nail that go vertically, like you describe, are increasingly common with age and not worrisome. Ridges that go horizontally across the nail sometimes are associated with medical illness, and are called Beau’s lines.

Many medical conditions are associated with Beau’s lines.

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