Symptoms may be of little help in the early detection of ovarian cancer

Symptoms like nausea, abdominal bloating, and pelvic pain may be of little help in detecting ovarian cancer early, when the chances of cure are best, according to a new study by researchers at Seattle’s Fred Hutchinson Cancer Research Institute.

Ovarian cancer is the ninth most common cancer among women (not counting skin cancers), according to the American Cancer Society.

Because ovarian cancer is usually detected late, it is often lethal, killing about 14,600 women in the U.S. each year.

Guidelines adopted by a number of organizations, including the American Cancer Society, recommend that such symptoms be used to identify women who should undergo medical evaluation with ultrasound and other testing in the hope of detecting ovarian cancer early while it is still curable.

But in the Seattle researchers found that while the majority of women who have the cancer do indeed commonly experience those symptoms before they are diagnosed, the symptoms appear for a relatively short time before diagnosis, whether or not they had early- or late-stage disease.

Moreover, because these symptoms are so common and ovarian cancer relatively rare, the Seattle team calculate it would be necessary to evaluate 100 women to find one ovarian cancer and around 200 women to detect an early stage cancer.

In the study, the researchers interviewed 812 women in Western Washington who had ovarian cancer and 1313 similar women who did not, asking them whether they had these symptoms and for how long.

Mary Anne Rossing, Ph.D., of the Program in Epidemiology at the Fred Hutchinson Cancer Research Center was the lead author of the study. Dr. Noel Weiss, M.D., Ph.D., also of the Hutchinson Center, was the senior author.

The paper was published Thursday online by the Journal of the National Cancer Institute.

In a phone interview, Dr. Weiss said that whether doctors should conduct the often costly medical evaluations of women with these symptoms when so many must be evaluated to find just one case is a value and economic judgement.

But even if this approach does identify women with ovarian cancer, it is still not clear that it will reduce their mortality, Dr. Weiss said. “It may not be early enough to make a difference.”

Advocates of the approach, he said, are “basically taking on faith that there is some benefit for the women with ovarian cancer who are identified by these means—that’s unproven.”

In an accompanying editorial, Dr. Llana Cass and Dr. Beth Y. Karlan, of the Division of Gynecologic Oncology at Cedars-Sinai Medical Center in Los Angeles write that the Seattle group’s findings suggest that it is not likely that evaluating women on the basis of symptoms alone will improve survival rates from ovarian cancer and “highlight the urgent need to develop better molecular markers and improved imaging modalities for ovarian cancer screening.”

ILLUSTRATION: Courtesy of the National Cancer Insitute – Alan Hoofring and Don Bliss

To learn more:

• Visit the Website of the Journal of the National Cancer Institute where the editorial and a press release are available for free. (Access to the paper requires a fee or subscription.)
• Visit the Website of the American Cancer Society, which has information about ovarian and other cancers.
• Visit the Website of the Fred Hutchinson Cancer Research Center’s Program for Epidemiology.

The

Tags: Cancer, OB/GYN, Ovarian Cancer, Women's Health

Category: Fred Hutchinson Cancer Research Center, Ovarian Cancer