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Symptoms don’t reliably predict ovarian cancer

Symptoms listed in consensus recommendation of little value for early detection

OnMedica Staff

Friday, 29 January 2010

Certain symptoms are more common in women with ovarian cancer but have little positive predictive value, especially when the disease is still at an early stage, finds a study this week in the online Journal of the National Cancer Institute.

In 2007 a consensus recommendation was issued by several gynaecology and cancer groups, in which they stated that certain symptoms – including abdominal pain or bloating, and urinary frequency – are more common in women with ovarian cancer than those without, and should trigger evaluation if present for more than a few weeks. They hoped that such prompt investigation could lead to earlier diagnosis and thus improve outcomes.

But the new research, from two US cancer centres, found that for every 100 symptomatic women evaluated, only one case of ovarian cancer would be detected.

The researchers interviewed 812 women, aged 35-74 years, who had been diagnosed with epithelial ovarian cancer. They asked them about the presence of persistent symptoms such as nausea, diarrhoea or constipation, pelvic or abdominal pain, bloating or feeling full, and urinary frequency or urgency, before their cancer diagnosis. They asked the same questions of 977 women who did not have ovarian cancer. They then analysed and compared the responses of cases and controls.

Only 24.0% of women with invasive ovarian cancer and 15.2% of those with borderline tumours had had no such symptoms persistently before diagnosis. Bloating or feeling full had occurred in 64.1% of women with invasive ovarian cancer and in 49.8% of those with borderline tumours. Also very common were pelvic or abdominal pain, which occurred in 60.9% of women with invasive and 48.8% of women with borderline disease.

Women with invasive rather than borderline tumours were more likely to report each symptom assessed; however, they also reported a more recent onset of symptoms than women with borderline disease.

Nausea was the only symptom more commonly reported by women with early-stage disease than by those with late-stage invasive cancer. The other symptoms were all reported more frequently by women with late-stage disease.

The authors say: “Although symptoms included in the index or consensus recommendations were much more common among women with ovarian cancer, even those with early-stage disease, than among women in general, the typically short interval from symptom onset to diagnosis suggests that rapid progression of most advanced tumours may limit their detection at an earlier stage.

“The use of symptoms to trigger medical evaluation for ovarian cancer is likely to result in a diagnosis of the disease in only one of 100 women in the general population with such symptoms.”

They conclude: “Our findings indicate that even pronounced differences in the symptom experience of case patients and control subjects may yield a very low positive predictive value of symptoms to detect ovarian cancer that results chiefly from the rarity of this disease …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.”

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