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Letters |

Osteopontin as a Biomarker for Ovarian Cancer

Robert C. Wallach, MD
JAMA. 2002;287(24):3208-3210. doi:10.1001/jama.287.24.3206.
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To the Editor: The article by Dr Kim and colleagues1 raises the false hope of finding "tumor markers that could be used to detect the early stages of the disease." It is not at all clear, and certainly not proved, that advanced stage ovarian carcinoma begins as a disease confined to the ovary (stage I). Frequently, patients with disseminated disease have relatively small tumor deposits in the ovaries and the primary tumor may have been on adjacent or distant peritoneal surfaces, or there may have been a multifocal origin.2 The extreme cases are those referred to as "peritoneal carcinoma" in which the ovaries seem uninvolved or have demonstrable secondary implants only. Finding stage I ovarian carcinoma early is a laudable ambition, and sensitive and specific tumor markers may be useful in this pursuit. However, the rapid progression of the disease and the multifocal nature suggest that efforts and money would best be directed to more effective and specific treatment rather than chasing the possibility of "early" disease. Experience with the CA125 marker, which is quite useful for measuring and following advanced disease, demonstrates that the likelihood of a sensitive marker improving survival is remote or nil. Also, it is to be expected that fearful patients and physicians will request the results for the marker in inappropriate situations as they currently do for CA125.

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