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Study suggests diagnoses often delayed for ovarian cancer patients



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Knight Ridder Newspapers

(KRT)

SAN JOSE, Calif. - Ovarian cancer - often called the "silent killer" because it usually goes undetected until it has spread - isn't so silent, a new study shows. And neither are many of the California women afflicted with it, some of whom have complained to doctors about their symptoms a full year before being diagnosed.

In one of the more objective research projects to track whether women show early signs of the disease, scientists at the University of California-Davis determined that nearly half of the 1,985 ovarian cancer patients studied told a doctor about their symptoms up to three months before their disease was diagnosed. And 7 percent had complained about abdominal pain, bloating or other disease signs 10 to 12 months earlier.

In many cases, doctors initially failed to perform the best tests for detecting the cancer.

"It suggests there's a potential for improving diagnosis," said Dr. Lloyd H. Smith, the lead researcher and chairman of the department of obstetrics and gynecology at UC-Davis.

The findings also have some patient advocates hoping that earlier diagnoses could translate into better patient outcomes and perhaps even fewer deaths - but that big wish remains unproven.

"The question is, are they having symptoms while it's still curable?" said Dr. Gary Friedman, a Kaiser Permanente researcher who was not involved with the current study. "We can't really say."

One of the problems in detecting the disease is that while it may not be silent, "it is subtle," said Dr. Barbara Goff, director of gynecologic oncology at the University of Washington who also was not involved in the study. In a study published last year, Goff found that many women remembered having symptoms several months before their diagnoses. But patients and physicians alike have the tendency to disregard the signs, she said.

That's because constipation, gas, pelvic pain, abdominal swelling, incontinence and other discomforts associated with the disease are "not symptoms that scream out at you," Goff said. "We have all probably experienced them from time to time."

While women should take notice if they have recurring symptoms that grow progressively worse or don't go away, they shouldn't panic if they have an occasional bout of constipation or gas. "Most women with bloating don't have ovarian cancer," Goff stressed.

In fact, ovarian cancer accounts for only about 3 percent of all cancers in women, with roughly 22,000 new cases of it diagnosed every year, according to the American Cancer Society.

Friedman, who looked at some Kaiser Permanente patients with the cancer, found in a study published in June that the symptoms are indeed vague and common, so common that "you might have to investigate several hundred" women complaining of abdominal pain or swelling "before you find one with ovarian cancer."

But the disease is often fatal. Only one in five cases are detected before the cancer has spread outside the ovary, when survival rates are much higher. More than half of women diagnosed with the cancer are dead within five years, statistics show.

The new UC-Davis study, which looked at the medical records of elderly Medicare patients across the state, determined that ovarian cancer could be diagnosed at least four months earlier in some patients if doctors were quicker to utilize several different tests.

Most often, doctors performed abdominal imaging tests or other gastrointestinal procedures when pelvic imaging and a blood test called CA125 are better at diagnosing ovarian cancer, Smith said. Only one-quarter of women complaining of symptoms underwent immediate pelvic imaging or blood testing.

"Unfortunately, there are a lot of women who don't have their complaints taken seriously," Goff said. "Both women and physicians need to pay a little bit more attention to these signs and symptoms."

Some experts said the new findings, which appear Monday on the Web site of the journal Cancer, will help to increase scientists' understanding of the disease. But only time will tell if earlier diagnoses will help save lives, said Dr. Ted S. Gansler of the American Cancer Society in a written statement.

"The dilemma we often face in thinking about early detection is: Are you detecting cancers early enough to make a difference in clinical outcomes," Gansler said, "or are you just giving someone bad news a few months earlier?"

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OVARIAN CANCER STUDY

A new UC-Davis study found that nearly half of 1,985 ovarian cancer patients studied had told a doctor about their symptoms up to three months before their disease was diagnosed. But the early symptoms are so common that they often are ignored or attributed to other ailments. They can include:

-Abdominal swelling

-Abdominal or pelvic pain

-Bloating and gas

-Constipation

-Incontinence

The study determined that ovarian cancer could be diagnosed at least four months earlier in some patients if doctors were quicker to utilize several different tests for patients with specific symptoms, including:

-Pelvic imaging

-The CA125 blood test

Source: Cancer; Mercury News reporting

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(c) 2005, San Jose Mercury News (San Jose, Calif.). Distributed by Knight Ridder/Tribune News Service.

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