Appropriate tests need to be done earlier for ovarian cancer

A new study to be published in the journal CANCER in October has found that many women diagnosed with ovarian cancer actually complained of symptoms of the disease at least four months before they were diagnosed.

Symptoms such as abdominal pain and swelling though not specific for ovarian cancer, but the researchers found that only about one quarter of women with these symptoms underwent pelvic imaging, or other tests to diagnose ovarian cancer.

Unfortunately ovarian cancer is considered a silent killer, often only coming to the attention of physicians at its late stages when prognosis is poor.

This is made even worse because this cancer has a deadly pattern in that it is a fast growing tumor, and can progress from early to advanced disease in as little time as a year.

There have been few studies on this disease but there is now increasing evidence to suggest patients may exhibit symptoms many months before advanced disease and diagnosis occurs.

In this study 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.

They found that 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, and as early as nine months were also more likely to complain of abdominal pain.

Overall, it was found that about 40 percent of these women had seen a doctor on one or more visits for abdominal or pelvic symptoms between 36 and 4 months before their ovarian cancer was diagnosed.

However 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.

While most received abdominal imaging or diagnostic gastrointestinal studies, that 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.

The authors concluded 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.

The study is to be published in the October 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

Ovarian Cancer: Who's at Risk?

The exact causes of ovarian cancer are not known. However, studies show that the following factors may increase the chance of developing this disease:

• Family history. First-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at increased risk of developing this type of cancer themselves. The likelihood is especially high if two or more first-degree relatives have had the disease. The risk is somewhat less, but still above average, if other relatives (grandmother, aunt, cousin) have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.

• Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60.

• Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.

• Personal history. Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had breast or colon cancer.

• Fertility drugs. Drugs that cause a woman to ovulate may slightly increase a woman's chance of developing ovarian cancer. Researchers are studying this possible association.

• Talc. Some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer.

• Hormone replacement therapy (HRT). Some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.