Symptom-triggered testing shows promise for identifying early-stage ovarian cancer

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Aug 19 2024

A recent International Journal of Gynecologic Cancer study evaluates the efficacy of symptom-triggered testing in detecting early-stage ovarian cancer.

Study: Symptom-triggered testing detects early stage and low volume resectable advanced stage ovarian cancer. Image Credit: Ground Picture / Shutterstock.com

Improving ovarian cancer patient outcomes

In the United Kingdom, ovarian cancer is the sixth most common cause of cancer-related deaths. Most women diagnosed with early-stage ovarian cancer, which is defined by the International Federation of Gynecology and Obstetrics (FIGO) as stage I or II, have better five-year survival rates as compared to women diagnosed with advanced stage ovarian cancer.

Clinical trials conducted in the U.K. and United States have demonstrated that screening for ovarian cancer can improve stage diagnosis but does not appear to significantly affect mortality rates. One key challenge that prevents the early diagnosis of ovarian cancer includes vague symptoms associated with this disease and its low prevalence rate.

Clinicians have identified a symptom triad that includes increased abdominal size and bloating, early satiety, and pain linked with ovarian cancer. Based on these symptoms, a symptom index was designed for national guidelines to increase awareness among clinicians.

Symptom-triggered testing for ovarian cancer has been endorsed by several U.K. and U.S.-based cancer organizations such as the American Cancer Society, Society of Gynecologic Oncology, and Foundation for Women’s Cancer. According to the U.S. National Institute for Health and Care Excellence (NICE), any woman should be referred to a gynecologist within two weeks of symptom detection. Thereafter, women should be tested for cancer antigen125 (CA125) levels and undergo a transvaginal ultrasound scan which, taken together, is referred to as a fast-track referral pathway.

Although the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) did not identify any benefit of ovarian cancer screening in reducing overall mortality rates, this screening approach has enabled the identification of women with high-grade serous ovarian cancer at stages I and II to ultimately improve short-term outcomes.

Early detection of ovarian cancer has the potential to increase the number of women receiving early treatments, such as surgery or adjuvant chemotherapy, which may ultimately improve survival rates.

About the study

The current descriptive study enrolled women who were recruited into Refining Ovarian Cancer Test accuracy Scores (ROCkeTS), an observational study designed to validate risk prediction models in pre- and post-menopausal women with suspected ovarian cancer. All women were diagnosed with high-grade serous ovarian cancer through the fast-track referral pathway.

Women between 16 and 90 years of age from different hospitals throughout the U.K. with high CA125 levels or/and abnormal imaging were considered for the study. All study participants completed a questionnaire at the beginning of the study and blood samples were collected to detect biomarkers.

The extent of the disease was classified as low, moderate, and high. Cytoreduction, which is defined as the residual tumor load, was also determined

Study findings

A total of 2,596 participants from ROCkeTS with a mean age of 63 years were recruited for the current study, 89.9% of whom were post-menopausal. Approximately 94% of women with high-grade serous ovarian cancer identified through the symptom-triggered fast-track pathway exhibited low-to-moderate disease spread and complete cytoreduction.

A complete cytoreduction or residual disease of one centimeter or less was achieved at surgery. Five patients did not receive any treatment.

The findings of the current study were consistent with the previously conducted DOvE pilot study, which revealed the possibility of high complete cytoreduction rates, even for patients with advanced high-grade serous ovarian cancer. The multimodal screening approach enabled the detection of a significant number of stage I and II high-grade epithelial ovarian cancer as compared with the ‘no screening’ arm, with detection rates of 25% and 14%, respectively.

Conclusions

The study findings indicate that about 25% of women with high-grade serous ovarian cancer, which is the most lethal subtype of ovarian cancer, can be detected at an early stage through the fast-track pathway following symptom-triggered testing. Symptom-triggered testing can efficiently detect women with low disease burden, potentially contribute to high complete cytoreduction rates, and may even improve survival outcomes in ovarian cancer patients.

There is a risk of selection bias in the present study, which is reflected in the observed stage distribution. Since the number of women recruited through the emergency pathway or from other outpatient referrals was modest, no statistically significant differences in performance status, disease stage, and cytoreduction rates were observed.