Symptom screening advances early ovarian cancer detection

A symptom survey may provide clinicians with a rapid, cost-effective screening tool to detect early stages of ovarian cancer, according to a new study. Published in the January 15, 2007 issue of CANCER (http://www.interscience.wiley.com/cancer-newsroom), a peer-reviewed journal of the American Cancer Society, the study reveals that early ovarian cancer may be distinguished from other causes by a specific set of symptoms and their frequency and duration.

Physicians generally consider ovarian cancer to be a "silent killer." That is, it develops asymptomatically or with symptoms easily attributable to benign causes until diagnosed late in the course of disease and well after a cure is likely. There is no effective screening test to detect early stage disease in the general population or even high-risk groups. Consequently, no professional gynecology association or public health agency recommends routine screening. Also, the lack of recognized, early clinical signs and symptoms delays diagnosis until advanced disease. These factors combine to make ovarian cancer one of the deadliest malignancies in the world.

Recent evidence suggests that early-stage symptoms may be recognizable and could be used to develop a symptom index for early disease. Led by Barbara A. Goff, M.D. of the University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center in Seattle, researchers compared the clinical history of women at high risk for developing ovarian cancer and women already diagnosed with ovarian cancer to develop a basic symptom index to screen for ovarian cancer.

They found "that a relatively simple evaluation of symptoms of recent onset and significant frequency" was sufficient to be a potential screening tool. Any complaint of pelvic/abdominal pain, increased abdominal size/bloating, or difficulty eating/feeling full that is present more than 12 days per month and for less than one year was 57 percent sensitive for early disease and 80 percent sensitive for advanced cancer; and 90 percent specific for women over 50 years of age and 86.7 percent for women under 50 years of age.

While Dr. Goff plans on evaluating a simple three question screening in a multi-year study in general clinical practice, "a symptom index, though, is only one of a number of promising research tracks the ovarian cancer advocacy community actively supports," writes Sherry Salway Black, Executive Director of the Ovarian Cancer National Alliance in Washington, D.C. in an accompanying editorial from the same issue. Although years away, the development of a screening blood test would be "the real key to early detection." She continues, "until there is a valid screening test, the symptom index could serve an important role in detecting cancers, and after a test is identified, the index could be a tool used in combination with other methods to contribute to early detection." In the meantime, according to Ms. Salway Black, health organizations will continue to educate women and physicians about "the symptoms so that if cancer develops, it is diagnosed early" because "at present, awareness of these symptoms is our best hope for early detection."

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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.

Editorial: "Ovarian Cancer Symptom Index: Possibilities for Earlier Detection," Sherry Salway Black, Susan Lowell Butler, Patricia A. Goldman, Mary Jackson Scroggins, CANCER; Published Online: December 11, 2006 (DOI: 10.1002/cncr.22414); Print Issue Date: January 15, 2007.


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