Signs from a silent killer

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 led by Dr. Barbara Goff of the Clinical Research Division, Seattle Cancer Care Alliance and University of Washington School of Medicine. The study, which appears in the Jan. 15 print edition of Cancer, reveals that early ovarian cancer may be distinguished 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 and well after a cure is likely. There has been no effective screening test to detect early stage disease in the general population or even high-risk groups. Consequently, no medical association or public health agency recommends routine screening.

Now, evidence by Goff and colleagues suggests that early stage symptoms may be recognizable and could be used to develop a symptom index for early disease. The 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. The screening symptoms include:

• 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.

This screening was 57 percent sensitive for early disease and 80 percent sensitive for advanced cancer; it was 90 percent specific for women over 50 years of age and 86.7 percent for women under 50 years of age.

Goff now plans to evaluate a simple three-question screening in a multiyear study in general clinical practice. Center co-authors include Drs. Nicole Urban and Robyn Anderson of the Public Health Sciences Division.