"Most women with ovarian cancer get inadequate treatment that cuts their survival short. Experts keep lamenting this wellknown problem. This spring for example a major report by the Institute of Medicine said that although women who receive care according to national guidelines have improved survival less than onehalf of women with ovarian cancer receive such care. What the report didnt say is that since  the U.S. Food and Drug Administration has approved two sophisticated blood tests that can help women get the optimal surgery for ovarian cancer. But the tests  OVA and ROMA  have not been widely adopted largely because they havent been recommended by the physician groups that write the care guidelines. The reasons are nearly as complex as ovarian cancer a disease with  new U.S. diagnoses and  deaths a year. Some experts say that the tests track records are too short or worry that the technology could be misused leading to unnecessary surgery or delayed diagnosis.  In any case the Texasbased company that developed OVA is trying hard to get traction for its test and a nextgeneration version called Overa which it says will be available in the coming year. Vermillion is marketing directly to women hiring celebrity ovarian cancer survivors for an awareness campaign with the catchphrase Know Pelvic Mass. Guiding treatment Pelvic mass is a catchall term for an abnormal growth in the ovaries or pelvic area. These lumps and enlargements are common and often get discovered incidentally during say a gynecological checkup. But some masses are tough to diagnose with certainty. Every year an estimated  women have surgery to do that. Thats where OVA or ROMA come in. They are approved to help decide whether the womans surgery should be done by a gynecologic oncologist instead of an obstetriciangynecologist or general surgeon. The referral to a gynonc can be crucial. Ovarian cancer has no earlydetection screening test so it is usually found after it has spread through the pelvis or beyond. Thus the operation to diagnose a suspicious mass may turn into a marathon cancer surgery called debulking. Gynoncs are trained in debulking removing all visible cancer in hopes that aggressive chemotherapy can kill remaining cells. The operation may involve taking out the spleen abdominal membranes and digestive organs as well as reproductive organs. OVA and ROMA fill a pretty small niche but an important one said Calaneet Balas vice president of the National Ovarian Cancer Research Fund Alliance an advocacy group. We know that if women have the surgery by a gynecologic oncologist first their outcomes are much better. ROMA sold by Fujirebio Diagnostics measures two blood proteins CA and HE. OVA measures those two and three more. The data are plugged into a proprietary formula to tell the patient whether shes at high or low risk of having a malignancy. ROMA is  to  OVA is  and insurance coverage varies according to the testmakers. Vermillion says a patient without insurance coverage pays a maximum of  for OVA. Companysponsored studies have shown that each test is better than physicians clinical judgment alone at identifying women who have cancer although the tests arent so good at ruling out noncancers. In studies that led to FDA approval combining ROMA or Ova with clinicians assessments better determined the patients who should be referred to a gynonc identifying well over  percent of the women who actually had cancer. Whether its ROMA or OVA I think these tests are useful said Richard Moore a University of Rochester gynonc who led Fujirebios approval study. The fine print Still he and others recognize that the technology could be misused for screening or diagnosis  purposes far beyond guiding the choice of a surgeon. Thats why the FDA requires each test to warn that incorrect use . . . carries the risk of unnecessary testing surgery andor delayed diagnosis. We are extremely careful when we explain what its use is for and not for said gynonc Judy Wolf Vermillions chief medical officer. But you cant control what doctors do. She said some doctors use the CA blood test for screening. Though CA is valuable to look for recurrence of cancer it is not recommended for screening because it can surge for example during menstruation. However guidelines from the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network NCCN recommend a CA test plus vaginal ultrasound imaging for a woman with nonspecific symptoms that could signal ovarian cancer such as bloating and pain. A CT or MRI scan may be added although these are expensive. A biopsy is usually avoided because it could spread cancer cells. If the diagnostic workup is worrisome or if the woman has a strong family history of breast or ovarian cancer the guidelines call for referral or consultation with a gynonc. But guidelines arent always followed. Consider ovarian cancer survivor Sherry Pollex . Two summers ago she was caught in what her boyfriend NASCAR driver Martin Truex Jr. calls patient pinball  bouncing between family doctor obgyn and gastroenterologist near their home in Mooresville NC. with no definite diagnosis. Ovarian cancer is rare in women under  so it wasnt an obvious suspect. However she says her obgyn didnt order a CA test even though she had ascites  fluid  in her abdomen and severe pelvic pain. She says he did multiple vaginal ultrasounds reassuring her that she had benign ovarian cysts. In desperation  and in retrospect luckily  she called a family friend a gastric surgeon who ordered a CT scan. That test led to an immediate referral to a gynonc which led to a sevenhour debulking surgery followed by chemotherapy. The CT scan image looked like a bomb went off in my body she said. From my pelvis to my diaphragm I was covered in tumors. Vermillion has hired Pollex and two other young highprofile ovarian cancer survivors  Olympic gymnast Shannon Miller and Broadway star Valisia LeKae  for the awareness campaign. Awaiting validation Robert E. Bristow a gynonc at the University of CaliforniaIrvine has published muchcited studies showing that most women with ovarian cancer receive suboptimal care shortening their lives by at least a year. In some cases women dont go to a gynonc for surgery because of distance there are only about  in the United States. But subtler problems persist. Some physicians dont have a full appreciation of the complexities of treatment said Bristow a paid consultant to Vermillion. Its this antiquated thinking Oh we just go in and do a hysterectomy and send the patient for chemo.  Such thinking is a bigger problem than identifying which women are likely to have cancer said David OMalley an Ohio State gynonc who helped write the NCCNs care guidelines. The problem is that sometimes even when they obgyns know there is ovarian cancer they arent making the referral OMalley said. So far the closest that ROMA and Ova have gotten to acceptance by physician groups is a  statement by the Society of Gynecologic Oncology. It says tests that measure blood proteins may be useful in making referrals to gynoncs. Moore the Rochester gynonc said he believes the tests just need more time to build a following. In  we had a few publications on ROMA Moore said. Since then weve probably had over  independent validations worldwide. As the validation is more evident youll see the community using these tests more and more."