Use of symptoms to trigger a medical evaluation for ovarian cancer does not appear to detect early stage ovarian cancer earlier and would likely result in diagnosis in only one out of 100 women in the general population with such symptoms, according to new findings published online Jan. 28 in the Journal of the National Cancer Institute.
The Public Health Sciences Division’s Dr. Mary Anne Rossing and colleagues assessed the predictive value of certain symptoms, including abdominal pain or bloating and urinary frequency, which were cited as a way to diagnose ovarian cancer earlier in a 2007 consensus statement by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.
For the current study, the researchers conducted in-person interviews with 812 patients age 35 to 74 years who had epithelial ovarian cancer that was diagnosed between 2002 and 2005. They compared the results from these patients with interviews of 1,313 population-based control subjects—women who did not have ovarian cancer. The researchers assessed the sensitivity, specificity, and positive predictive value of a proposed symptom index and of symptoms included in the consensus recommendation.
Symptoms appeared in the ovarian cancer patients only about five months or less before diagnosis. Women with early stage ovarian cancer were somewhat less likely to have symptoms (except nausea) than those with late stage cancer.
The authors concluded that 100 symptomatic women would need to be evaluated to detect one woman with ovarian cancer.
“The low positive predictive value of symptoms to detect ovarian cancer—particularly at an early stage—argues for a cautious approach to the use of symptom patterns to trigger extensive medical evaluation for ovarian cancer,” the authors wrote.
Editorial comments
In an accompanying editorial, Drs. Beth Karlan and Ilana Cass of the Cedars-Sinai Medical Center in Los Angeles, noted the strengths of the study, including in-person interviews and large number of patients, but also wrote of its potential recall bias, which is always a possibility in case–control studies because case subjects may be more likely to remember symptoms than control subjects.
“Importantly, these findings remind us that wide recognition of symptoms alone will not incrementally improve the overall survival from ovarian cancer,” the editorialists wrote. “Rather, they highlight the urgent need to develop better molecular markers and improved imaging modalities for ovarian cancer screening.”
The National Institutes of Health funded the study.
[Adapted from a JNCI news release.]
