Category Archives: Ovarian Cancer

01.12.12

Annual Sonogram Screening Prolongs Ovarian Cancer Survival, but Does it Save Lives?

Results from the Kentucky Ovarian Cancer Screening Study at first glance look incredibly promising.  Among the over 37 thousand women who underwent annual pelvic sonograms, the 5-year survival rate for all women with ovarian cancer in the screened group was 75% compared with 54% for unscreened women with ovarian cancer from the same institution treated exactly the same otherwise. The investigators attribute this increased survival to earlier detection – 70% of the screened group were diagnosed at stage I or II, compared with only 27% in the un-screened group. Stage III cancers tended to be earlier (IIIa and IIIB instead of IIIC), and there were no stage IV cancers among women who were screened.

The investigators markedly improved on the positive predictive value of screening by boldly refusing to go where others have always gone before – to the operating room. They stood firm and watched cysts grow to as large as 10 cm before intervening, provided those cysts did not bear the defining characteristics of malignancy – namely solid areas and papillary internal growths. They also were not afraid to tweek their triage algorithm as experience with sonography improved. This is perhaps the biggest contribution from the study – permission to watch and wait.

Following a mean of 5.5 screens in 37,293 women, the authors achieved a specificity of 98.5% and a PPV of 8.9% with 11.1 operations per case of primary invasive epithelial ovarian cancer. This compares with a specificity of 98.4% and 19.5 operations per case of primary invasive epithelial ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, in which both ultrasonography and CA 125 were used as first-line tests.

But a closer look reveals important questions that must be answered before we can begin to recommend screening in the general population.

1. Could the results be explained by the healthy volunteer effect? This was not a randomized trial, just a comparison between women in the screening program and the rest of the population who got ovarian cancer in the same time frame outside the program.  We all know that folks who volunteer for studies such as this tend to be healthier in general than the overall population, thus skewing survival statistics in their favor. In this study, however, survival was equivalent between control and screened groups diagnosed in early stages, suggesting that it was indeed the stage shift that led to higher survival in screened groups and not just a healthy volunteer effect.

2.  How about lead time effect? This happens when cancer is identified a little earlier, giving the false impression that folks are living longer when it is really that they have just learned a little earlier about the diagnosis that ultimately will lead to their demise. All screening studies have this potential bias. This is why overall mortality and not just survival time must be the relevant statistic to compare between screened and unscreened groups.

3. Not all cancers were caught by sono. Twelve women developed cancer in the year after a normal screening test, with 7 deaths due to cancer in this group. Such aggressive tumors may never lend themselves to early detection, no matter what modality is used.

4. Major surgery remains the only way to ultimately diagnose ovarian cancer. In the Kentucky trial, 523 women, or about 1.4% of participants  screened ended up in the OR, and 86% of these women did not have cancer.  Until we have a less invasive was to get reliable pathology on ovarian cysts, we are going to be exposing healthy women to unnecessary surgery while chasing the elusive early diagnosis.  While this may be marginally acceptable in high risk women, expanding screening to the general population will lead to millions of avoidable operations, with their consequent risks, costs and mortality.

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Long-term survival of women with epithelial ovarian cancer detected by ultrasonographic screening. van Nagell JR, Miller RW, DeSimone CP, Ueland FR, Podzielinski I, Goodrich ST, Elder JW, Huang B, Kryscio RJ, Pavlik EJ Obstet Gynecol. 2011 Dec; 118(6):1212-21

Jacobs,I; Menon,U. Can Ovarian Cancer Screening Save Lives? The Question Remains Unanswered. Obstet & Gynecol. 118(6):1209-1211, December 2011.

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06.05.11

Annual Ovarian Cancer Screening – More Harm than Good

In a large multicenter study enrolling over 70,000 women, annual screening with transvaginal pelvic ultrasound and ca125 blood testing did not reduce deaths from ovarian cancer, and in fact led to an increase in complications due to screening.

Investigators in the NCI-sponsored Prostate, Lung and Ovarian Cancer (PLCO) Screening trial randomly assigned over 78,000 women age 55-64 years of age to either annual screening with transvaginal pelvic sonograms for 4 years plus CA125 testing for 6 years or usual care at 10 study sites across the US., and followed the groups for up to 13 years. Over that time period, ovarian cancer rates in the screened group were 5.7 per 10,000 person-years vs 4.7 per 10,000 persons-years in the usual care group, with 3.1 deaths vs 2.6 deaths per 10,000 person years, respectively. Over 3000 women had false positive screening results, a third of whom had surgery and 15% of those operated on had a complications from their surgery. Deaths from other causes did not differ between the groups.

The investigators concluded that annual screening for ovarian cancer does not reduce mortality, and in fact caused harms among women with fals positive abnormal results.

This is not the first study that failed to find efficacy for ultrasound and ca125 in reducing mortality from ovarian cancer, but it is certainly among (if not ) the largest.

Whether or not more frequent sonogram screening, combining ca125 with other serum markers, or trending ca125 levels over time (rather than just looking for “abnormal” results) will prove to be effective ovarian cancer screening has yet to be determined. Studies continue to be done, although preliminary results to date on these have not been encouraging.

What I do in My Practice

I tell my asymptomatic, low-risk patients who ask me for ovarian cancer screening that annual sonograms are like kissing the Blarney Stone. It makes us all feel lucky for awhile, but actually does nothing to reduce ovarian cancer mortality.

Still, I have not refused occasional screening for  anxious women (Often women who have had a friend recently diagnosed with ovarian cancer0), so long as they understand the limitations of screening, but seem to need that negative sonogram to sleep at night.  I do respect their anxiety, and if that means an occasional scan in the office and a reassured patient, I don’t see much harm, and they are told up front that their insurance may not cover the scan.  I also happen to refer to a great radiologist who does not overcall abnormals, so if I see anything of concern, I refer straight to him.  Now that we have this data regarding adverse outcomes due to over-screening, I will share that with my patients, and may be able to stand a bit more firmly in refusing to order ineffective screening to asymptomatic but anxious women.

For women at increased risk (family history of ovarian cancer, BRCA gene mutation carriers), I do offer vaginal sonogram and ca125 screening, but at minimum of twice a year, and urge these women to instead enroll on one of the several ovarian cancer screening trials currently in progress.

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More on this topic from around the Web

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09.08.10

Prophylactic Oophorectomy in BRCA Carriers Reduces Mortality

Removal of the ovaries (oophorectomy) in women who carry harmful BRCA mutations prevents both ovarian and breast cancer, and reduces overall mortality.

In a landmark study published last week in JAMA, researchers followed 2343 women with BRCA1 and BRCA2 mutations for a mean of 3-6 years (range 0.5-27 yrs), and compared cancer and mortality outcomes between those who had risk-reducing surgery (172 had mastectomy and 993 had removal of the ovaries) and those who chose not to have surgery. Those who did not have surgery were offered aggressive surveillance for breast cancer (annual mammography and breast MRI) and ovarian cancer (ultrasound and Ca125 testing every 4-12 months).

In women who underwent risk-reducing salpingo-oophorectomy, 1.1% were subsequently diagnosed with ovarian cancer (ie, primary peritoneal cancer), 11.4% were subsequently diagnosed with breast cancer, and 3.1% subsequently died of any cause. In women who did not undergo risk-reducing salpingo-oophorectomy, 5.8% were subsequently diagnosed with ovarian cancer, 19.2% with breast cancer, and 9.8% subsequently died from any cause.

Ovarian cancer risks were higher in BRCA 1 (7-8%) than BRCA2 carriers (3%) who kept their ovaries. No BRCA2 carriers who had their ovaries removed got peritoneal cancer during the follow up. (This is consistent with prior literature on these mutations and ovarian cancer risks.) Nine women who had their ovaries removed had small occult ovarian cancers diagnosed in the removed ovaries.

Prophylactic oophorectomy was also protective against primary breast cancer, cutting the risk in half – from 22% to 11%. In women who had prior breast cancer, oophorectomy reduced the odds of a second breast cancer from 14% to 11%.

Prophylactic oophorectomy appears to be more effective in BRCA2 than BRCA1 carriers – there were no breast or ovarian cancer-related deaths in BRCA 2carriers who had their ovaries removed.  The surgery appeared to be of equal value in women over and over age 50.

While prophylactic mastectomy indeed reduced the risk of acquiring breast cancer (no women who had the surgery got breast cancer), it did not impact mortality.

Bottom Line

Women who carry harmful BRCA mutations have a markedly increased cancer risk ; 15-40% will develop ovarian cancer in their lifetime (compared to about 1% of the general population) and 6-% will develop breast cancer (compared to 12% of the general population of women).

While we can offer BRCA mutation carriers effective screening for breast cancer (mammogram, sonogram and MRI), we do not have an equally effective screening tool for ovarian cancer. Even the much touted ultrasound and Ca125 tests have not been shown to reduce mortality from ovarian cancer. In this study, in fact, women were offered sonograms and Ca125 testing, and although we do not know to what extent they actually availed themselves of the surveillance, it clearly did not offer them the same protection against ovarian cancer as oophorectomy.

The protective effect of oophorectomy in carriers of harmful BRCA mutations stands in marked contrast to oophorectomy in women at average risk of ovarian cancer, which has been shown to actually increase mortality when performed in women under age 65.

What are the risk factors for having a harmful BRCA mutation?

About 2% of women have risk facotrs for BRCA 1 and 2 mutations. According to the NCI, these are -

For women who are not of Ashkenazi Jewish descent :

  • two first-degree relatives (mother, daughter, or sister) diagnosed with breast cancer, one of whom was diagnosed at age 50 or younger;
  • three or more first-degree or second-degree (grandmother or aunt) relatives diagnosed with breast cancer regardless of their age at diagnosis;
  • a combination of first- and second-degree relatives diagnosed with breast cancer and ovarian cancer (one cancer type per person);
  • a first-degree relative with cancer diagnosed in both breasts (bilateral breast cancer);
  • a combination of two or more first- or second-degree relatives diagnosed with ovarian cancer regardless of age at diagnosis;
  • a first- or second-degree relative diagnosed with both breast and ovarian cancer regardless of age at diagnosis; and
  • breast cancer diagnosed in a male relative.

For women of Ashkenazi Jewish descent -

  • any first-degree relative diagnosed with breast or ovarian cancer; and
  • two second-degree relatives on the same side of the family diagnosed with breast or ovarian cancer.

Women who have none of these family history patterns have a low probability of having a harmful BRCA1 or BRCA2 mutation.

How I Will Use these Study Results

I encourage women with suggestive family histories to see a genetic counselor to discuss BRCA testing. Despite making many such referrals,  I find most women don’t follow through.  ”Why should I want to know?” they ask.  ”What would I do differently if I had the BRCA gene other than worry?”

It’s an important question that deserves an answer. So I tell them -

We would offer prophylactic oophorectomy. That’s because we have no good screening that has been proven to reduce ovarian cancer mortality. But if we remove the ovaries, we can significantly reduce the odds of getting both ovarian and breast cancer.  With this new study, I can now tell these women that this cancer risk reduction also translates to a significant reduction in mortality. And give them some numbers to chew on as they think about what, if anything, they want to do.

The decision to proceed to oophorectomy is never undertaken lightly. Which is why BRCA testing is helpful – it may allow us to avoid surgery in women who test negative for harmful mutations. It is also why we offer oophorectomy at too young an age and certainly not until childbearing is completed in women who do carry harmful mutations. Sometime in the 40′s seems about the right age for oophorectomy in BRCA mutation carriers. The surgery can usually be done laparoscopically, with same day discharge in many cases.

The price we pay for oophorectomy, of course, is menopause. Menopause that we may not want to treat with estrogen because of your predisposition to breast cancer. However, there are non-hormonal ooptions for hot flashes that can be effective. And here it can get complicated, as some patients decide to have a hysterectomy as well as an oophorectomy, so that they can take unopposed estrogen, which (at least in the WHI) is not associated with an increased risk for breast cancer. (Not unreasonable thinking, in my opinion…) But these are just some of the things you’ll want to think about before considering prophylactic oophorectomy.

I don’t push prophylactic mastectomy, although it is certainly an option for BRCA carriers. This study makes this feel even more reasonable, because while mastectomy certainly prevented breast cancer, it did not significantly reduce mortality from breast cancer. I suspect that is because we’re pretty darned good at screening for breast cancer, and have very effective treatments. But some women will choose mastectomy regardless.

For women with suggestive family histories who choose either not ot know their BRCA status, or who opt for surveillance only, I encourage enrollment in a clinical trial of new screening methods for ovarian cancer. For those who don’t do this, I will do ca125 and sonograms, simply for the lack of anything else better to do.

One of these days, we’ll hopefully have an effective screening test for ovarian cancer. But until then, prophylactic oophorectomy remains an important option for women at increased risk for ovarian and breast cancer due to harmful BRCA mutations.

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NCI Fact Sheet on BRCA mutation testing

NCI Bulletin on this research study

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02.04.10

Screening for Ovarian Cancer Based on Symptoms – Not Good Enough

Thanks to Toni Brayer for pointing out this new study on ovarian cancer symptoms published in the Journal of the National Cancer Institute.

This study confirms previous studies which found that ovarian cancer, long thought to be a silent disease in its early stages, does indeed have symptoms. The problem is that those symptoms – bloating, urinary frequency, pelvic pain, early satiety – are common, non-specific and, according to this new study, 99% of the time not due to an underlying ovarian cancer.

That’s good news, of course, for women with these symptoms. But bad news for those hoping for a means of early detection for ovarian cancer, since early symptom recognition is neither sensitive nor specific enough to be useful as a screening test on a population basis.
This is extremely important for women to understand. Each new screening test gets over-hyped and sets women up with unrealistic expectations about just what it is we docs can do to diagnose this disease. (The latest hope comes from a study that found elevated serum markers in women with ovarian cancer up to three years before their cancer was diagnosed. Unfortunately, the test were not useful in discriminating normals from abnormals until shortly before diagnosis.)
I don’t know if the results of this new symptom screening study will lead to changes in the current recommendations for ovarian cancer screening, so for now I will just reiterate them here –
If you have any of the following symptoms almost daily for more than a few week and these symptoms represent a change from normal for you, see your doctor, preferably a gynecologist.
  • Bloating
  • Pelvic or abdominal pain
  • Urinary urgency or frequency
  • Difficulty eating or feeling full quickly

Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Remember, though, that these symptoms are almost always caused by something other than ovarian cancer.


Wouldn’t it be great if we had a pill to prevent ovarian cancer?
Wait a minute – we already do! It’s call the Birth Control Pill. According to the National Cancer Institute, use of the pill for even as little as a year lowers ovarian cancer risk by 10-12%, and there is a 50% risk reduction after 5 years of use. Other studies show even higher risk reduction with longer term use.
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Those ovarian cancer awareness wristbands up there are sold to raise funds for the Lynne Cohen Ovarian Cancer Research Foundation. The Susan Komen Foundation sells them too. The Ovarian Cancer Research Fund has a whole store!

More info on ovarian cancer screening from The National Cancer Institute.

21 Comments
05.12.09

Ovaries – If they’re Normal, Leave them Alone


That’s what I’ve been telling my patients for years. And I will continue to say it after reading the results of a recent study comparing long term health outcomes in women whose ovaries were removed at time of hysterectomy for benign disease to those whose ovaries were left in place. The study found that women who had oophorectomy (removal of the ovaries) had an increased risk for death from cardiovascular disease. How high?

With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.

That’s a significant risk, I’d say.

As expected, women whose ovaries were removed had a lower risk of ovarian cancer, probably the most common reason some doctors give for removing normal ovaries at the time of hysterectomy. But this benefit was far outweighed by the cardiovascular risks conferred by removing the ovaries.

A surprising new finding in this study was an increased risk of lung cancer in women whose ovaries were removed. There is not obvious biologic reason for this, so it remains unexplained (and could be a statistical aberration).

The overall study findings were not surprising

Previous studies have found that removal of the ovaries confers increased risk of death from cardiovascular disease, which also occurs more frequently in women who undergo premature menopause. A decision analysis published in 2005 using data available at that time suggested age 65 as the cutoff for leaving the ovaries in place, since after that age, there was no added benefit. This more recent study suggests there should be no upper age limit.

What I found interesting in this study was that removal of the ovaries at the time of hysterectomy for benign disease did not appear to confer protection against future ovarian in women with a family history of ovarian cancer. This stands in direct contrast to well done prospective randomized data showing a clear benefit to prophylactic oophorectomy in this group. The authors suggest that their findings support a benefit from hysterectomy alone in preventing ovarian cancers, perhaps from a disruption of the influx path for potential carcinogens or changes in hormonal or triggering pathways. This would suggest that a randomized trial of hysterectomy without oophorectomy in women at high risk for ovarian cancer might be in order. (Currently, when prophylactic oophorectomies are done, the uterus is frequently kept in place.) It’s an interesting idea, but one that would need to be well-studied before suggesting anything other than current practice for these women.

Is there ever a reason to remove the ovaries?

Absolutely. If a woman has cancer of the ovary, the risk for death far, far outweighs any benefit to leaving the ovaries. (The exception is the young women with very early stage unilateral or borderline ovarian cancer – more limited surgery is generally offered to these women.)

Uterine cancer is also an indication for oophorectomy. Again, exceptions are often made in premenopausal women with early stage uterine cancers, and some of these women are being treated hormonally rather than with surgery. It will be interesting to see if anyone uses these study findings to recommend against removal of the ovaries in older women with very early stage uterine cancer.

I find the more difficult women to counsel are those having a hysterectomy for endometriosis with ovarian involvement, or for pelvic abscess or adhesions trapping a normal ovary and causing severe pain. For these women, the risk of continued pain and stress related to it, as well as the potential risks for additional surgery needs to be weighed against their risks for cardiovascular disease. The stress associated with chronic pain should not be minimized. For some of these women, removal of the ovaries may continue to be appropriate.

What if you’ve had your ovaries out?

It’s important to remember that oophorectomy is not the only modifiable risk factor for heart disease – diet, exercise, and treatment for underlying conditions such as hypertension and elevated cholesterol are just as important (and may be even more so). There is still an awful lot you can do to be sure you maximize your odds of beating heart disease as you age.

Oophorectomy is not the same as a hysterectomy

Hysterectomy is removal of the uterus. Oophorectomy is removal of the ovaries. Other than the risks associated with having surgery itself, hysterectomy alone does not confer an increase risk of mortality, and, unlike oophorectomy, does not increase long term heart disease risks. For many women, hysterectomy remains an important option for treatment of benign conditions such as uterine fibroids.
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Image from Wikpedia Commons

7 Comments
01.18.09

Ovarian Cancer and Obesity – Weighing the Risks

A recent research study reports an increased risk of ovarian cancer among obese women.

Since every woman I know thinks she is fat, this report is sure to raise anxiety levels across the board. So let’s see if I can calm things down a bit by placing the data in perspective.

First off, you need to know your BMI. Go here and calculate it , then come back. For those of you who are too lazy to click the link, you can think of it this way – your BMI is 30 if you are 5’2″ and 150 lbs, 5’5″ and 180 lbs or 5’8″ and 200 lbs.

Got your BMI? Okay. Here’s the data -

Women with a BMI of 30 or more had a relative risk of 1.6 for ovarian cancer compared to women whose BMI is < 25. That means for every 1 case of ovarian cancer in the thin women, there were 1.6 cases among the obese women. Almost double the rate. Sounds pretty bad, right?

Well, that depends on how risky ovarian cancer is to start with. Turns out ovarian cancer is not that common, whether you are thin or fat. The risk in this study was less than 1% over the 7 years of the study.

Here’s how it looks visually – There are 1000 dots in each group, representing 1000 women. The red dots represent the women who got ovarian cancer in the 7 years of the study.

What about the risk among HRT users? Well, in that group, obese women’s risk for ovarian cancer was no higher than thinner women’s risk, because thinner women on HRT have a higher risk of ovarian cancer than their thin counterparts who don’t use HRT. How high?  For every 1000 women on HRT there were 3-4 cases of ovarian cancer. Same as with obese women.

Bottom Line

Obesity increases your risk for ovarian cancer. Fortunately, that risk is still quite low – certainly not high enough to warrant anything other than routine screening.

But add it to the increased risks of diabetes, hypertension, hyperlipidemia, heart disease and breast cancer associated with obesity, and maybe it’s enough to get you thinking more seriously about losing  weight. Not to mention the improvement in your quality of like when you can sleep without snoring or apnea, exercise comfortably, wear the clothes you love and just plain feel better.

8 Comments
07.09.07

Total Inhibin – A New Ovarian Cancer Screening Test?

If researchers in Siena, Italy, are right, measurement of Inhibin, a hormone molecule produced by the ovary, could be an effective ovarian cancer screening test.

In a study published this month in The Journal of Clinical Endocrinology and Metabolism, the researchers measured total Inhibin levels using an Elisa-based assay, comparing results in women with ovarian cancers to those of normals and those with benign ovarian tumors and other cancers. Total Inhibin levels were highly sensitive and specific in detecting ovarian cancers. When combined with Ca125 levels, the results were superior to either test alone. (See graph above).

The percentage of cancers detected at 95% specificity varied according to the histological subtype but was always improved by the combination of total inhibin and CA-125. In detail, the detection rate of all tumors raised from 84–87% with single markers to 99% with combined markers (P < .05). The addition of total inhibin increased the CA-125 detection rate for mucinous tumors from 14 of 17 (82%) to 17 of 17 cases (100%) without loosing specificity (95%). Remarkably, the detection rate of clear cell adenocarcinomas increased from 59–68% with single markers to 96% with combined markers (P < .05)

The next step is a large multicenter trial.

Inhibin has been on the radar as a potential ovarian cancer marker for some years now. The problem has been that there are various Inhibin molecules, and the different kinds of ovarian cancers make one or more of these in any combination. Most Inhibin assays are specific to one or more of the subtypes, which limits them in detecting all ovarian cancers. It seems that the total Inhibin assay used in this study may have worked so well because of its lack of specificity, making it more useful as a screening test.

What I found most exciting is that the inhibin assay used is one that is already commercially available, meaning that, if these results hold true, then we won’t have to wait very long to implement screening.

Stay tuned…

7 Comments
06.14.07

Ovarian Cancer Symptoms

Gilda Radner, who died of ovarian cancer at the age of 42,
had symptoms for months before her cancer was finally diagnosed.

The American Cancer Society and the Society for Gynecologic Oncologists have issued a consensus opinion outlining the symptoms of ovarian cancer, and more importantly, urging women and their doctors to consider ovarian cancer in the differential diagnosis when these symptoms present.

What are the symptoms? They are vague and all too common – bloating, pelvic or abdominal pain, early satiety, and urinary sympotms such as urgency and frequency. But, when present and persistent for more than 2 weeks and less than 1 year (or in the case of urinary symptoms, persistent after treatment for a UTI), one must consider ovarian cancer in the differential. And consider it early, because this is one cancer that won’t wait around while you exclude everything else.

For almost 2 decades now, this is exactly how I have been practicing. As I’ve said before, I don’t hesistate a second before performing a pelvic ultrasound in women with any of the symptoms listed in the consensus statement. I happen to be pretty good with a vaginal ultrasound probe, and I have an amazing gynecologic radiologist to whom I can refer.

Despite this, in all these years, after performing or referring for thousands of sonograms (and not a few ca125 tests) in what I believe is an optimally aggressive screening approach for ovarian cancer in symptomatic women, I have yet to diagnose a single case of early ovarian cancer. Of the 5 or so cases (it is, after all, not a common cancer), all but one presented to me at stage 3 or more. That early tumor was a borderline cancer, and she would have done well no matter what I had done.

I wish I could say my aggressive management of symptoms has impacted ovarian cancer mortality. It’s certainly reassured a lot of frightened women and found quite a bit of benign disease. But ultimately, I just don’t think it has made a difference in terms of ovarian cancer outcomes.

Maybe it is because my patients with ovarian cancer ignored their symptoms for too long before coming in to see me. If so, then publicizing this consensus statement may make a difference. I certainly hope that it does. And despite my reservations about my practice’s efficacy, I’m not changing what I do, because at this point, there is nothing else I can do. It’s what I have to do, and what my patients deserve.

What we really need is a good early ovarian cancer screening test for asymptomatic women. (No, it’s not the Ca125 test.)

Or better yet, how about a pill to prevent ovarian cancer? Oh, wait a minute – we already have that. It’s called the Birth Control Pill.

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Here’s the Consensus Statement:

Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.

18 Comments
01.30.06

Ovarian Cancer Screening – Telling It Like It Is

A very well-written article in USA Today honestly tells readers why an Ovarian Cancer Test Remains Elusive.

I spend a lot of time discussing ovarian cancer screening with my patients who come in anxious about the disease. Most of that time is spent explaining that, unfortunately, we still don’t have a good screening test for ovarian cancer.

I aggressively screen with ultrasound and CA 125 in women with a family history or personal risks factors for ovarian cancer. And I don’t hesitate a second to get a pelvic ultrasound in any woman complaining of the vague, non-specific symptoms associated with this cancer – bloating, early satiety, abdominal pain. (I don’t wait for other tests to be negative before ordering an ultrasound, because even though ovarian cancer is not common, it is usually rapidly growing, and won’t wait for me to finish my workup.)

But for low risk women without any complaints, I really have no screening test to offer, and this article does a nice job explaining why.

Unfortunately, what the writer does not tell women is that there is something they can do that will actually lower their risk of getting ovarian cancer in the first place. What’s that? Go on birth control pills. As little as 3 months of use imparts protection, and long term users can expect up to an 80% reduction in risk. Now that’s something to write about.

If you want more information about ovarian cancer screening and prevention, see these great web sites:
National Cancer Institute
The OvarianCancer Coalition
Contraception Online
Johns Hopkins Pathology

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