Which of the following is not a recommended cancer screening group?

• A. None of the above
• B. AFP/subjects at high risk for liver cancer
• C. PSA/men over 50 with at least 10 years of life expectancy
• D. CA 125/women of reproductive age

Answer: (D)

Screening tests work best when the cancer is relatively common in the group and the test has good accuracy, so that true cases are found and false positives are minimized. CA-125 is not a good screening marker for ovarian cancer in women who are of reproductive age because ovarian cancer is uncommon in this group and CA-125 can be elevated for many benign reasons (such as menstruation, pregnancy, endometriosis, or inflammation). This leads to many false positives, unnecessary follow-up tests and procedures, and no proven mortality benefit from screening in average-risk women. Therefore, routine screening with CA-125 in reproductive-age women is not recommended. In contrast, AFP is used for liver cancer screening in people at high risk (where the disease is more prevalent), and PSA-based discussion about screening can occur in some guidelines for men with longer life expectancy, reflecting a more favorable balance of benefits and harms in those contexts.