- Medina, Jamie;
- Annapragada, Akshaya;
- Lof, Pien;
- Short, Sarah;
- Bartolomucci, Adrianna;
- Mathios, Dimitrios;
- Koul, Shashikant;
- Niknafs, Noushin;
- Noë, Michaël;
- Foda, Zachariah;
- Bruhm, Daniel;
- Hruban, Carolyn;
- Vulpescu, Nicholas;
- Jung, Euihye;
- Dua, Renu;
- Canzoniero, Jenna;
- Cristiano, Stephen;
- Adleff, Vilmos;
- Symecko, Heather;
- van den Broek, Daan;
- Sokoll, Lori;
- Baylin, Stephen;
- Press, Michael;
- Slamon, Dennis;
- Konecny, Gottfried;
- Therkildsen, Christina;
- Carvalho, Beatriz;
- Meijer, Gerrit;
- Andersen, Claus;
- Domchek, Susan;
- Drapkin, Ronny;
- Scharpf, Robert;
- Phallen, Jillian;
- Lok, Christine;
- Velculescu, Victor
Ovarian cancer is a leading cause of death for women worldwide in part due to ineffective screening methods. In this study, we used whole-genome cell-free DNA (cfDNA) fragmentome and protein biomarker (CA-125 and HE4) analyses to evaluate 591 women with ovarian cancer, benign adnexal masses, or without ovarian lesions. Using a machine learning model with the combined features, we detected ovarian cancer with specificity >99% and sensitivity of 72%, 69%, 87%, and 100% for stages I-IV, respectively. At the same specificity, CA-125 alone detected 34%, 62%, 63%, and 100% of ovarian cancers for stages I-IV. Our approach differentiated benign masses from ovarian cancers with high accuracy (AUC=0.88, 95% CI=0.83-0.92). These results were validated in an independent population. These findings show that integrated cfDNA fragmentome and protein analyses detect ovarian cancers with high performance, enabling a new accessible approach for noninvasive ovarian cancer screening and diagnostic evaluation.