Early Clinical Signs of Ovarian Cancer
Symptoms of Ovarian Cancer
Many women diagnosed with ovarian cancer actually complained of symptoms of the disease at least four months before they were diagnosed, according to a new study to be published in the October 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society. Although patient complaints of abdominal pain and swelling are not specific for ovarian cancer, the researchers found that only about one quarter of women with these symptoms underwent pelvic imaging, or other tests to diagnose ovarian cancer, in a timely manner.
Ovarian cancer has been thought of as a silent killer, coming to the attention of physicians only at its late stages when prognosis is poor. Adding to ovarian cancer’s deadly pattern is that it is a fast growing tumor, progressing from early to advanced disease in as little time as a year. There has been increasing evidence for this poorly studied disease to indicate patients may exhibit symptoms many months before advanced disease and diagnosis occurs.
Lloyd H. Smith, M.D., Ph.D. from the University of California, Davis Medical Center in Sacramento and colleagues compared diagnosis codes and claims for diagnostic procedures among 1,985 elderly women with ovarian cancer, 6,024 elderly women with localized breast cancer, and 10,941 age-matched Medicare-enrolled women without cancer.
As early as 12 months before diagnosis, women with ovarian cancer were at least twice as likely to present to a physician with abdominal swelling or pelvic pain. As early as nine months before diagnosis, women with ovarian cancer were also more likely to complain of abdominal pain. Overall, about 40 percent of these women had physician claims indicating one or more visits for abdominal or pelvic symptoms between 36 and 4 months before their ovarian cancer was diagnosed.
Only 25 percent of ovarian cancer patients had diagnostic pelvic imaging or CA125 serum tests during the period from 36 to 4 months before diagnosis. Most received abdominal imaging or diagnostic gastrointestinal studies, which would be less likely to help establish the correct diagnosis. By contrast, 54 percent of ovarian cancer patients received pelvic imaging or CA125 serum testing within 3 months before their ovarian cancer was diagnosed.
"Our findings suggest that ovarian cancer could be diagnosed earlier in some patients whose diagnosis is currently delayed by at least 4 months because physicians order abdominal imaging or perform gastrointestinal procedures before they order a test more likely to diagnose ovarian cancer, such as pelvic imaging and/or CA125," conclude the authors.
"While increasing 'lead time' is the manner in which a successful screening test can find cancer at a more favorable stage, the value of increasing lead time can only be determined if it is associated with a reduced death rate," said Ted Gansler, MD, the American Cancer Society's director of medical content. "In and of itself, demonstrating longer survival is not the outcome of importance for making decisions about screening or diagnostic testing. Unless earlier detection measurably increases survival, reduces mortality, or improves quality of life, its relevance to real medical practice remains uncertain. The dilemma we often face in thinking about early detection is: 'Are you detecting cancers early enough to make a difference in clinical outcomes, or are you just giving someone bad news a few months earlier (hence, the appearance of a longer survival time)?' Of course, it's always important for clinicians to keep ovarian cancer in mind when women mention symptoms, but that situation is far different than offering screening tests to an asymptomatic, average risk woman."
Article: "Ovarian Cancer: Can We Make the Clinical Diagnosis Earlier?" Lloyd H. Smith, Cyllene R. Morris, Shagufta Yasmeen, Arti Parikh-Patel, Rosemary D. Cress, Patrick Romano, CANCER; Published Online: August 22, 2005 (DOI: 10.1002/cncr.21310); Print Issue Date: October 1, 2005. - ATLANTA 2005/08/22
Many women diagnosed with ovarian cancer actually complained of symptoms of the disease at least four months before they were diagnosed, according to a new study to be published in the October 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society. Although patient complaints of abdominal pain and swelling are not specific for ovarian cancer, the researchers found that only about one quarter of women with these symptoms underwent pelvic imaging, or other tests to diagnose ovarian cancer, in a timely manner.
Ovarian cancer has been thought of as a silent killer, coming to the attention of physicians only at its late stages when prognosis is poor. Adding to ovarian cancer’s deadly pattern is that it is a fast growing tumor, progressing from early to advanced disease in as little time as a year. There has been increasing evidence for this poorly studied disease to indicate patients may exhibit symptoms many months before advanced disease and diagnosis occurs.
Lloyd H. Smith, M.D., Ph.D. from the University of California, Davis Medical Center in Sacramento and colleagues compared diagnosis codes and claims for diagnostic procedures among 1,985 elderly women with ovarian cancer, 6,024 elderly women with localized breast cancer, and 10,941 age-matched Medicare-enrolled women without cancer.
As early as 12 months before diagnosis, women with ovarian cancer were at least twice as likely to present to a physician with abdominal swelling or pelvic pain. As early as nine months before diagnosis, women with ovarian cancer were also more likely to complain of abdominal pain. Overall, about 40 percent of these women had physician claims indicating one or more visits for abdominal or pelvic symptoms between 36 and 4 months before their ovarian cancer was diagnosed.
Only 25 percent of ovarian cancer patients had diagnostic pelvic imaging or CA125 serum tests during the period from 36 to 4 months before diagnosis. Most received abdominal imaging or diagnostic gastrointestinal studies, which would be less likely to help establish the correct diagnosis. By contrast, 54 percent of ovarian cancer patients received pelvic imaging or CA125 serum testing within 3 months before their ovarian cancer was diagnosed.
"Our findings suggest that ovarian cancer could be diagnosed earlier in some patients whose diagnosis is currently delayed by at least 4 months because physicians order abdominal imaging or perform gastrointestinal procedures before they order a test more likely to diagnose ovarian cancer, such as pelvic imaging and/or CA125," conclude the authors.
"While increasing 'lead time' is the manner in which a successful screening test can find cancer at a more favorable stage, the value of increasing lead time can only be determined if it is associated with a reduced death rate," said Ted Gansler, MD, the American Cancer Society's director of medical content. "In and of itself, demonstrating longer survival is not the outcome of importance for making decisions about screening or diagnostic testing. Unless earlier detection measurably increases survival, reduces mortality, or improves quality of life, its relevance to real medical practice remains uncertain. The dilemma we often face in thinking about early detection is: 'Are you detecting cancers early enough to make a difference in clinical outcomes, or are you just giving someone bad news a few months earlier (hence, the appearance of a longer survival time)?' Of course, it's always important for clinicians to keep ovarian cancer in mind when women mention symptoms, but that situation is far different than offering screening tests to an asymptomatic, average risk woman."
Article: "Ovarian Cancer: Can We Make the Clinical Diagnosis Earlier?" Lloyd H. Smith, Cyllene R. Morris, Shagufta Yasmeen, Arti Parikh-Patel, Rosemary D. Cress, Patrick Romano, CANCER; Published Online: August 22, 2005 (DOI: 10.1002/cncr.21310); Print Issue Date: October 1, 2005. - ATLANTA 2005/08/22
