Ovarian cancer detection made easy with simple symptom survey

Published: Saturday, Sep 22, 2012, 20:57 IST 

A simple three-question paper-and-pencil survey, given to women in the doctor’s office in less than two minutes, can effectively identify those who are experiencing symptoms that may indicate ovarian cancer, a new study has revealed.

The study by researchers at Fred Hutchinson Cancer Research Center represents the first evaluation of an ovarian cancer symptom-screening tool in a primary care setting among normal-risk women as part of their routine medical-history assessment.

Early detection of ovarian cancer is key to survival. Cure rates for those diagnosed when the disease is confined to the ovary are approximately 70% to 90%. However, more than 70% of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20% to 30%.

The researchers evaluated the effectiveness and feasibility of several different symptom screening surveys.

After a few tweaks to formatting and content, the version that proved most effective contained three questions that asked whether a woman was currently experiencing one or more of the following symptoms, all of which have been identified previously as potentially indicative of ovarian cancer.

The symptoms were abdominal or pelvic pain, feeling full quickly or unable to eat normally and abdominal bloating or increased abdomen size.

The survey also asked about the frequency and duration of these symptoms: how many days a month and for how long.

“Symptoms such as pelvic pain and abdominal bloating may be a sign of ovarian cancer but they also can be caused by other conditions. What's important is to determine whether they are current, of recent onset and occur frequently,” M. Robyn Andersen, lead author of the study, said.

Previous research by Andersen and colleagues has found that about 60% of women with early-stage ovarian cancer and 80% of women with advanced disease report symptoms that follow this distinctive pattern at the time of diagnosis.

“Women with symptoms that are frequent, continual and new to them in the past year should talk to their doctor, as they may be candidates for further evaluation with ultrasound and blood tests that measure markers of ovarian cancer such as CA-125,” she said.

“Recent research indicates that approximately one in 140 women with symptoms may have ovarian cancer. Aggressive follow-up of these symptoms can lead to diagnosis when ovarian cancer can be caught earlier and more effectively treated,” she said.

The study involved 1,200 women, age 40 to 87, who were seen in a Seattle women's health clinic. More than half of the study participants reported being postmenopausal and approximately 90% were white.

About half of the clinic visits were for a current health concern or for follow-up of a health problem reported at an earlier visit. The other half were for routine appointments such as mammography screening.

Of those surveyed, 5% had a positive symptom score that indicated the need for further testing. Of this group of about 60 women, one was diagnosed with ovarian cancer shortly thereafter.

Of the 95% of women who tested negative on the symptom survey, none developed ovarian cancer during a 12-month follow-up period, which attests to the accuracy of the screening tool.

Those who reported current symptoms on the questionnaire or reported other medical concerns scored higher than those who did not. Non-white women were also about twice as likely to receive a positive symptom score as compared to white women.

“If ovarian cancer screening using symptoms is widely adopted, maximising the specificity of screening programs will be important,” the authors wrote.

“Until better biomarkers are identified and tested, collecting information about symptoms appears to have promise,” they added.

The bottom line, Andersen said, is that the screening tool can be used easily in a primary-care setting, is acceptable to patients and providers, and identifies women with symptoms that are worthy of concern with minimal false-positive results.

The study has been published online in the Journal of Obstetrics and Gynecology.

DNA Daily News & Analysis

Ovarian cancer screenings not recommended as a routine

Sept 2012

By Lena H. Sun, Published: September 10

A federal government task force recommended Monday that women not get routinely screened for ovarian cancer because doing so can put them at increased risk for unnecessary harm, such as major surgery.

The U.S. Preventive Services Task Force, an independent group of national experts, said it continues to discourage screening in women at average risk for ovarian cancer, which has the highest mortality rate of all types of gynecological cancer and is the fifth-leading cause of cancer death among women.

Although the task force made the same recommendation in 2004, the panel’s latest recommendation is based on the largest clinical trial published so far. It confirms previous findings, the task force chairman said.

“It was a pretty definitive study. It confirmed what we thought was the case,” said Virginia Moyer, the panel chair. Half the women in the study were screened with transvaginal ultrasounds and a blood test called CA-125, which is how screening is typically done. The other half of the women were not screened. There were 78,216 women in this trial.

“It made no difference in the outcome,” she said.

But a high percentage of women who undergo screening experience false-positive tests that then require invasive testing, such as major surgery to open up the abdomen and take out the ovary, she said.

“That puts those women at increased risk for being harmed. That’s major surgery.”

She said the task force tries to update its recommendations every five years based on new evidence. Its last recommendation against routine screening for ovarian cancer was issued in 2004. In 2008, review of the literature was commissioned by the task force and revealed no new evidence about the benefits of screening.

The task force did not make a recommendation, Moyer said, because the large clinical trial was underway.

Moyer said screening guidelines by other medical and public health organizations are in line with the panel’s. For example, the American Congress of Obstetricians and Gynecologists does not recommend screening for ovarian cancer in women who are not showing symptoms. Also, the American Cancer Society says there is no screening test proven to be effective and sufficiently accurate in the early detection of the cancer.

Women’s health advocates said the latest recommendation does show that better screening tools need to be developed.

“The important thing to remember is that if women do have symptoms or have a family history of ovarian cancer, they need to see a doctor,” said Pat Goldman, founder of the Ovarian Cancer National Alliance. Symptoms include persistent urinary or bowel changes or pelvic pain, or a feeling of fullness when you haven’t eaten.

Ovarian cancer is difficult to detect, so listen to your body

By Tara M. Ibarbo / For Healthy U

Posted:   09/03/2012 12:03:23 AM MDT

"It whispers, so listen." This slogan will always remind me of ovarian cancer. When I was in my second semester of nursing school, one of our first presentation style assignments was to pick a chapter in our nursing book and create a learning experience for our peers. Naturally my deep appreciation for cancer as a subject led me straight to its chapter. I was not only given an opportunity to research and uncover more about cancer, but I had the chance to choose one specific type of cancer and educate my peers. I opted for not only one of the most serious forms of cancer, but a cancer that always seems to have the least amount of attention. During my investigation I discovered one of the most profound slogans I have ever read and will forever remain aware of "It whispers, so listen."

So what exactly does this slogan mean? What it means is ovarian cancer usually does not produce any early symptoms, and when it does, they are so similar to typical symptoms of constipation, stomach upset, menstrual cramping and back pain, they essentially "whisper" and are commonly ignored. The key to "listening" to symptoms is really being familiar with your body. Usually if the unusual changes last longer than two weeks, it is important to seek medical attention. The major changes to pay attention to are: vaginal bleeding or discharge that is not normal for you, pelvic or low abdominal pain, back pain that persists, bloating in the lower region of your abdomen, feeling full quickly after eating, or a change in your bathroom habits — for instance prolonged constipation or diarrhea.

There is no screening for ovarian cancer, and please keep in mind that a Pap smear test will not detect this particular type of cancer; it is used as a screening tool for cervical cancer. The only prevention is listening to your body and noticing changes.

There are a few risk factors linked to ovarian cancer, which include: age, being of Eastern European (Ashkenazi) Jewish background, never giving birth, having a history of endometriosis, and genetic mutations. Two particular mutations called BRCA1 or BRCA2, are not only connected to breast cancer, but ovarian as well. They stand for BR (br-east) and CA (ca-ncer) and there are two susceptibility genes, thus the 1 and 2. If this gene is inherited, a woman's risk is significantly increased. The National Cancer Institute indicates that 1.4 percent (14 out of 1,000) will be diagnosed with ovarian cancer, compared with 15 to 40 percent (150-400 out of 1,000) of women who have a harmful BRCA1 or BRCA2 mutation. So, if there is a family history, especially close family, such as mother, sister, aunt or grandmother on either your father or mother's side of the family, it is important that your doctor is aware. Testing can be expensive and controversial, so it is important to talk to your health care provider if you feel you should have this done.

Teal is the awareness color for ovarian cancer and also stands on its own as a motto for bringing awareness. TEAL=Take Early Action & Live. As a reminder, September is Ovarian Cancer Awareness Month. If you would like to learn more about ovarian cancer, visit the National Ovarian Cancer Coalition website, www.ovarian.org.

Tara M. Ibarbo is a BSN/RN/ CTR employed at Memorial Medical Center Cancer Center and a current MPH graduate student at New Mexico State University.

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