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SACRAMENTO, Calif. -- Ovarian cancer could be diagnosed earlier in some women if more doctors conducted simple tests that can, with limited reliability, detect the often fatal disease, researchers at UC Davis have concluded.
Often called the "silent killer," ovarian cancer in fact does produce symptoms, but they are vague and hard to distinguish from other, far more common ailments. That has made the disease deadlier than others because most often it is caught too late.
"Ovarian cancer is very treatable if it can be found early," said Dr. Lloyd Smith, who specializes in gynecological cancers at Davis and conducted the research. "When it is confined to the ovaries, survival is 85 to 90 percent after five years."
But 75 to 80 percent of cases are found when the disease has spread, he said, reducing the five-year-survival rate to just 15 to 20 percent.
Smith examined the Medicare claims of 1,985 California women ages 68 and older who had ovarian cancer, and compared them to women diagnosed with breast cancer and women without cancer.
He found that women diagnosed with ovarian cancer were far more likely to have complained prior to their diagnosis of bloating, gas, a feeling of fullness, abdominal pressure and pelvic pain -- all symptoms of ovarian cancer -- than the other patient groups.
The findings, published in Monday's online edition of the journal Cancer, represent the first objective analysis of ovarian cancer symptoms. Earlier studies relied on the subjective recollection of symptoms by patients already diagnosed with ovarian cancer. The authors examined specific symptom codes submitted to Medicare by doctors.
"The take-home message here is that if patients are complaining of significant symptoms, they may be indicative of an ovarian malignancy, and they should perhaps be taken more seriously than they have been in the past," said Robert Smith, director of cancer screening for the American Cancer Society, who is not related to Lloyd Smith, the study author.
Ovarian cancer advocacy groups Monday said the findings give credence to what they have known for years: that ovarian cancer is not silent, but that it can cause miserable symptoms for up to a year and that tests need to be done within weeks of symptoms, not months.
"This study tells me there is still a lot of education that needs to be done," said Dr. Judith Wolf, a gynecological oncologist at the University of Texas M.D. Anderson Cancer Center and head of the medical advisory board at the National Ovarian Cancer Coalition.
Internal medicine and family practice doctors typically rule out gastrointestinal ailments before considering a test for ovarian cancer, said Smith, the UC Davis researcher.
"It's very difficult to make a diagnosis of ovarian cancer," he said. "I don't think it's that doctors aren't looking for it.
It doesn't point to itself. It's a rare disease."
A doctor may, for example, order a colonoscopy or even a costly CT scan for a woman complaining of unexplained abdominal problems.
But Smith's research found that while tests to target ovarian cancer symptoms were frequently used within three months prior to diagnosis of ovarian cancer, relatively few patients were given them earlier, when the disease is most curable.
Specifically, the study found that four in 10 women with ovarian cancer tell their doctors about symptoms at least four months -- and up to a year -- before being diagnosed.
Although there is no screening test for ovarian cancer as there are for other malignancies such as the Pap smear for cervical cancer and mammogram for breast cancer, two tests are useful in diagnosing ovarian cancer and deciding how to approach treatment.
One is pelvic imaging, in which technicians use ultrasound to look for abnormalities in the shape of the ovaries. The other is a blood test, called CA-125 which detects proteins that show up in higher concentrations when certain cancers are present.
Unfortunately, imaging can produce false negatives and positives, which can lead to an unnecessary surgery, the researcher said. The blood test detects only about half of early stage ovarian cancers and 80 percent of later stage disease.
Specialists typically use both tests to get a firm diagnosis.
Smith, the UCD researcher, emphasized that the tests should not be used as screening tools, but only to diagnose cases when symptoms have persisted and other potential causes are ruled out. Editor Notes: (From McClatchy News Service, for use by New York Times News Service clients.)
c.2005 The Sacramento Bee
