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Shelly Rozenberg meets many women who think they don't have to worry about ovarian cancer because they had a normal Pap test.
"We constantly have to educate women: The Pap test is not an early-detection test for ovarian cancer," says Rozenberg of the National Ovarian Cancer Coalition in Boca Raton, Fla.
Pap tests screen for malignant and precancerous cells in the cervix, not the ovary. Pap tests can detect ovarian cancer, but usually only advanced cases. The same is true for pelvic exams, which can pick up earlier cancers in other organs.
Scientists are studying several possible tools, mainly blood tests and sonograms, for screening for ovarian cancer. But they have yet to find a test that can pick up most early cases without mistakenly identifying many healthy women as having the disease. Over a lifetime, a woman has a 1-in-55 risk of getting ovarian cancer.
Nearly three in four ovarian cancers aren't diagnosed until they have spread beyond the ovaries, making the disease the fourth-leading cancer killer of U.S. women. And though studies have found that ovarian cancer patients often report symptoms long before diagnosis, the symptoms resemble those of far more common ailments.
A year ago or so, doctors and women were excited about a blood test called OvaCheck, billed as a way of finding ovarian cancer at its earliest stages. But some scientists question the design and results of initial studies of OvaCheck, which looks for patterns of proteins.
Annette Fribourg of OvaCheck maker Correlogic Systems says the company is still discussing with the Food and Drug Administration how the test should be categorized, which would affect how long it takes to move through the agency. She said she could not predict when the test might reach the market.
Most screening research has focused on a blood test for a protein called CA-125, elevated in many women with ovarian cancer, and transvaginal ultrasound, an ultrasound performed with a small instrument placed in the vagina.
Scientists from the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial found a large number of false positives -- healthy women identified as possibly having cancer -- when they screened 28,816 women with CA-125, transvaginal ultrasound or both.
Of that group, 1,338 had abnormal ultrasounds and 402 had abnormal CA-125 tests, the researchers wrote in November's American Journal of Obstetrics & Gynecology. Only 29 had cancer, but 570 had surgery to see whether they had cancer. Only 34 women had both abnormal ultrasounds and CA-125 tests, and nine of them were found to have cancer. But had doctors evaluated only women with two abnormal screening tests, they would have missed 20 cancer cases.
The trial will screen women for the next several years to see whether changes in test results over time relate to a woman's risk of dying from ovarian cancer, says lead author Saundra Buys, a University of Utah cancer specialist. Still, Buys says, based on other research, women with a strong family history of breast cancer or ovarian cancer might consider regular screening with transvaginal ultrasound and CA-125. The greater a woman's risk of ovarian cancer, the lower her chance of having a false positive result.
Some ovarian cancer patients report that they had symptoms months before diagnosis, but doctors are more likely to suspect problems in the digestive tract. In a study in the journal Cancer in October, researchers examined medical claims for nearly 2,000 ovarian cancer patients and about 17,000 women who did not have ovarian cancer. The cancer patients were more likely to have sought care for abdominal pain and swelling, pelvic pain and digestive tract problems than the other women.
Lead author Lloyd Smith, chairman of obstetrics and gynecology at the University of California-Davis, stresses that the vast majority of women with such symptoms don't have ovarian cancer. But those who suddenly experience them should have a CA-125 test, transvaginal ultrasound or both, he and his co-authors say.
"Probably it's going to cost a lot, and most people are not going to have cancer, but how else are you going to find the people who do?" Smith says.
Not so fast, says Debbie Saslow, the American Cancer Society's director of breast and gynecological cancers. "What happens if for every 100 women who report one of these symptoms, one of them develops ovarian cancer in the next year? Are you going to do these tests on all 100 women?" Half the time, the tests will erroneously suggest something is wrong with the ovaries, which could lead to unnecessary surgery, Saslow says.
"I'm not saying don't look for ovarian cancer, but there's another side of this," she says. "If a woman comes in for abdominal bloating, no, you're not going to look for ovarian cancer right away. If she's got a combination of symptoms, and they're getting worse over time, then by all means, do the tests."
Women must be their own advocates, Saslow emphasizes. If symptoms persist, and tests for more common ailments reveal nothing, she says, "make sure you get tested with the imperfect tests that are available."
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