Symptom Screening May Detect Ovarian Cancer Earlier

Reproduced from “Reuters Health” (NEW YORK DEC 11, 2006)
Anthony J. Brown, Reuters Health, Dec 11, 2006

U.S. researchers have identified six symptoms that could prove useful in screening women for ovarian cancer. By setting a duration and frequency for the symptoms, the investigators were able to detect ovarian cancer with high specificity.

Ovarian cancer has been called the "silent killer" because it was thought that symptoms only occur once the disease reaches an advanced stage, according to the report in the January 15th issue of Cancer.

However, in an earlier study, the current research group showed that this may not be the case. In an interview with Reuters Health, lead author Dr. Barbara A. Goff said: "We showed that symptoms can still occur even with early-stage disease, which raises the possibility of early detection and treatment."

Still, using symptoms for ovarian cancer screening has proven problematic. According to Dr. Goff, a gynecologic oncologist at the University of Washington School of Medicine in Seattle, the problem is that "the symptoms are nonspecific." Symptoms "such as abdominal pain, urinary urgency, and bloating, also apply to a number of benign diseases. They could even be present in a man for that matter."

To identify symptoms predictive of ovarian cancer, the researchers analyzed data from 149 women with ovarian cancer, 255 high-risk women involved in a screening program, and 233 women referred for pelvic or abdominal ultrasound. The subjects were randomly divided into an exploratory cohort and a confirmatory cohort.

Six symptoms were independently associated with an increased risk of ovarian cancer: pelvic pain, abdominal pain, increased abdominal size, bloating, difficulty eating and feeling full. All of these symptoms can be seen with a variety of diseases, but the researchers found that if any of them occur more than 2 times per month and have been present longer than 1 year, it greatly increased the odds of ovarian cancer.

In the confirmatory cohort, the symptom index was 56.7 percent and 79.5 percent sensitive in detecting early- and late-stage ovarian cancer, respectively. In women older and younger than 50 years, the index was 90 percent and 86.7 percent specific in identifying ovarian cancer.

Dr. Goff said that the symptom index "is not ready for prime time.
What we really need now is a prospective study to see how this performs when we use it on every woman over, say, age 40. We need to determine the costs of such screening and whether it actually leads to earlier diagnosis of ovarian cancer" and improved outcomes.

Cancer Prevention Clinic Team Response

The CPC care team would like to stress that there is currently no effective screening method for ovarian cancer, but it's being carefully researched.

SOURCE: Cancer 2006;109.
Article: "Development of an Ovarian Cancer Symptom Index:
Possibilities for Earlier Detection," Barbara A. Goff, MD, Lynn S.
Mandel, Charles W. Drescher, Nicole Urban, Shirley Gough, Kristi M.
Schurman, Joshua Patras, Barry S. Mahony, M. Robyn Andersen, CANCER; Published Online: December 11, 2006 (DOI: 10.1002/cncr.22371); Print Issue Date: January 15, 2007.