Screening by CA125 and Transvaginal Ultrasound for Ovarian Cancer in Postmenopausal Women: A Pilot Study in Malwa Region of Punjab

  • Ratika SamtaniEmail author
  • Roumi Deb
Original Article



The causes of ovarian cancer are multifold and the incidence is increasing gradually. The aim of the study is to screen for ovarian cancer at the population level among postmenopausal women belonging to a rural belt, Malwa region of Punjab, India, where cancer incidence is on a rise.


A total of 726 postmenopausal women from 33 villages of Talwandi Sabo block, Bathinda district, Punjab, India, participated in the ovarian cancer screening. Serum CA125 estimation followed by transvaginal ultrasound was done in order to detect any signs of ovarian carcinoma.


Mean level of CA125 was 8.15 (SD 11.59) U/ml with an interquartile range of 3.0–8.81 U/ml. Of the 726 postmenopausal women screened for ovarian cancer risk, 24 women (3.3%) were observed with elevated levels of CA125 (> 35 U/ml). No case of complex cyst/ovarian carcinoma was detected. Mean level of CA125 was higher with increasing age at menopause. 93.4% of the women were agriculturalists. A higher mean CA125 level was observed in women involved in agriculture (8.05 U/ml) as compared to non-agricultural women (5.87 U/ml).


The proportion of women detected with abnormal CA125 levels in the present study is quite large, and women of the region should be monitored regularly for any increase in CA125 levels. It is the earnest need of the hour to organize large-scale awareness and screening camps in villages of Talwandi Sabo block, Punjab, India, especially those in remote locations having minimum access to medical care facilities.


CA125 Ovarian cancer Postmenopausal women Menopause Agriculture 



Ovarian cancer


Age-adjusted incidence rate


Endocrine-disrupting chemicals


Cancer antigen 125


Enzyme-linked immunosorbent assay


Transvaginal ultrasound


Prostate, lung, colorectal and ovarian screening trial



This study was supported by funding from Rajiv Gandhi Centre for Biotechnology, Department of Biotechnology (DBT), Ministry of Science and Technology, India (6242-P86/RGCB/PMD/DBT/RKSN/2015), awarded to Dr Ratika Samtani. The authors express deep gratitude to the village heads and women of Punjab, India, who participated in the study and contributed to the research work.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rauh-Hain JA, Krivak TC, Del Carmen MG, Olawaiye AB. Ovarian cancer screening and early detection in the general population. Rev Obstet Gynecol. 2011;4(1):15–21.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Klint A, Tryggvadottir L, Bray F, et al. Trends in the survival of patients diagnosed with cancer in female genital organs in the Nordic countries 1964–2003 followed up to the end of 2006. Acta Oncol. 2010;49:632–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Consolidated Report of Population Based Cancer Registries 2001–2004. National Cancer Registry Program. Bangalore: Indian Council of Medical Research; 2006.Google Scholar
  5. 5.
    National Centre for Disease Informatics and Research. National Cancer Registry Program. Report of Punjab cancer atlas for year 2012–2013.
  6. 6.
    Kumar G, Kaur A. Factors responsible for cancer in Bathinda: socio-economic impacts. Int J Adv Res Manag Soc Sci. 2014;3(8):92–103.Google Scholar
  7. 7.
    Thakur J, Rao B, Rajwanshi A, Parwana HK, Kumar R. Epidemiological study of high cancer among rural agricultural community of Punjab in Northern India. Int J Environ Res Public Health. 2008;5(5):399–407.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mittal S, Kaur G, Vishwakarma GS. Effects of environmental pesticides on the health of rural communities in the Malwa Region of Punjab, India: a review. Hum Ecol Risk Assess Int J. 2014;20(2):366–87.CrossRefGoogle Scholar
  9. 9.
    Samtani R, Sharma N, Garg D. Effects of endocrine-disrupting chemicals and epigenetic modifications in ovarian cancer: a review. Reprod Sci. 2018;25(1):7–18.CrossRefPubMedGoogle Scholar
  10. 10.
    Ries LAG, Melbert D, Krapcho M, et al. editors. SEER cancer statistics review, 1975–2004. Bethesda: National Cancer Institute; 2006. Based on November 2006 SEER data submission, posted to the SEER website, 2007.
  11. 11.
    Nustad K, Bast RC Jr, Brien TJ, et al. Specificity and affinity of 26 monoclonal antibodies against the CA 125 antigen: first report from the ISOBM TD-1 workshop. International Society for Oncodevelopmental Biology and Medicine. Tumour Biol. 1996;17(4):196–219.CrossRefPubMedGoogle Scholar
  12. 12.
    Kabawa WE, Bast RC, Welch WR, Knapp RC, Colvin RB. Immunopathologic characterization of a monoclonal antibody that recognizes common surface antigens of human ovarian tumors of serous endometrioid and clear cell types. Am J Clin Pathol. 1983;79(1):98–104.CrossRefGoogle Scholar
  13. 13.
    Grzybowski W, Beta J, Fritz A, et al. Predictive value of CA 125 in detection of ovarian cancer in pre- and postmenopausal patients. Ginekol Pol. 2010;81(7):511–5.PubMedGoogle Scholar
  14. 14.
    Woolf B. On estimating the relation between blood group and disease. Ann Hum Genet. 1995;19(4):251–3.CrossRefGoogle Scholar
  15. 15.
    Jacobs IJ, Skates S, Davies AP, et al. Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: a prospective cohort study. BMJ. 1996;313(7069):1355–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Terada KY, Elia J, Kim R, Carney M, Ahn HJ. Abnormal CA125 levels in menopausal women without ovarian cancer. Gynecol Oncol. 2014;135(1):34–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ahuja M. Age of menopause and determinants of menopause age: a PAN India survey by IMS. J Midlife Health. 2016;7(3):126–31.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Morabia A, Costanza MC. International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Am J Epidemiol. 1998;148(12):1195–205.CrossRefPubMedGoogle Scholar
  19. 19.
    Thomas F, Renaud F, Benefice E, de Meeus T, Guegan JF. International variability of ages at menarche and menopause: patterns and main determinants. Hum Biol. 2001;73:271–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Ossewaarde ME, Bots ML, Verbeek AL, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology. 2005;16(4):556–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaur J. Association of morphological parameters and psychosocial stresses with age at menopause. Nurs Midwifery Res J. 2008;4(1):1–6.Google Scholar
  22. 22.
    Johnson CC, Kessel B, Riley TL, et al. The epidemiology of CA125 in women without evidence of ovarian cancer in the prostate, lung, colorectal and ovarian cancer (PLCO) screening trial. Gynecol Oncol. 2008;110(3):383–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Pathak RK, Parashar P. Age at menopause and associated bio-social factors of health in Punjabi women. Open Anthropol J. 2010;3:172–80.CrossRefGoogle Scholar
  24. 24.
    Mokha R, Kaur AI, Kaur N. Age at menarche in urban-rural Punjabi Jat Sikh girls. Anthropologist. 2006;8(3):207–9.CrossRefGoogle Scholar
  25. 25.
    Kumar D, Goel NK, Puri S, Gupta N. Correlates of age at menarche among unmarried girls in UT Chandigarh. Int J Curr Res Rev. 2015;7(8):45–52.Google Scholar
  26. 26.
    Malhi P, Singh S. Son preference and reproductive behaviour in rural Punjab. Guru Nanak J Sociol. 1995;16(2):31–40.PubMedGoogle Scholar
  27. 27.
    Sidhu S. Reproductive life of some Gujar women of Punjab. Indian J Phys Anthropol Hum Genet. 1986;12(3):225–33.PubMedGoogle Scholar
  28. 28.
    International Institute for Population Sciences (IIPS), Ministry of Health and Family Welfare, Government of India (2009–2010). Global Adult Tobacco Survey India (GATS India), 2009–10, India.Google Scholar
  29. 29.
    Chavan BS, Arun P, Bhargava R, Singh GP. Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh: a community survey. Indian J Psychiatry. 2007;49(1):44–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Key TJ, Davey GK, Appleby PN. Health benefits of a vegetarian diet. Proc Nutr Soc. 1999;58:271–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Gameiro C, Romao F. Changes in the immune system during menopause and aging. Front Biosci (Elite ed). 2010;2:1299–303.CrossRefGoogle Scholar
  32. 32.
    Kulkarni P, Rani BB, Kumar DS, Manjunath R. Burgeoning menopausal symptoms: an urgent public health concern. J Midlife Health. 2016;7(2):83–7.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, Cooper GS. Pesticide exposure and timing of menopause: the Agricultural Health Study. Am J Epidemiol. 2006;63(8):731–42.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  1. 1.Amity Institute of Anthropology, Room 219, J3 BlockAmity University NoidaNoidaIndia

Personalised recommendations