Raise the antenna on ovarian cancer
The woman sitting in front of you tells you that she has been experiencing abdominal pain, abdominal swelling, gastrointestinal symptoms, and pelvic pain. What is your next move?
According to a new study, four in 10 women with ovarian cancer have symptoms that they tell their providers about at least four months — and as long as one year — before they are diagnosed.1
"We found that women with ovarian cancer began to have more abdominal swelling, compared to control women, 10-12 months before diagnosis, and abdominal pain seven to nine months before diagnosis," says lead author Lloyd Smith, MD, PhD, professor and chair of the department of obstetrics and gynecology at the University of California Davis Health System in Sacramento. "When diagnostic testing was employed [four to 36 months before diagnosis], most women were sent for abdominal imaging and/or gastrointestinal procedures, and relatively few had pelvic imaging or CA-125 [cancer antigen-125] tests that could lead to a diagnosis of ovarian cancer."
According to the American Cancer Society, ovarian cancer is the seventh most common cancer in women and ranks fourth as the cause of cancer death in women. About 22,220 new cases of ovarian cancer will be diagnosed in 2005; about 16,210 women will die of the disease, according to the organization.2
Ovarian cancer often is thought of as a silent killer, coming to the attention of health care providers only at its late stages when prognosis is poor. This new research suggests that ovarian cancer could be diagnosed earlier in some patients.
To perform the study, researchers compared diagnosis codes and claims for diagnostic procedures for 1,985 elderly women with ovarian cancer, 6,024 elderly women with localized breast cancer, and 10,941 age-matched Medicare-enrolled women without cancer.
The investigators found that patients with ovarian cancer were more likely than women in the other two groups to have seen their providers for four particular symptoms: abdominal pain, abdominal swelling, gastrointestinal symptoms, and pelvic pain. Almost half of women with ovarian cancer had physician claims indicating one or more visits for such symptoms four months or more prior to a diagnosis of cancer.
One-quarter of the ovarian cancer patients who reported symptoms four or more months before diagnosis had diagnostic pelvic imaging or CA-125 blood tests. Most of the patients who reported early symptoms received abdominal imaging or diagnostic gastrointestinal studies, tests that are less likely to detect the disease. Within three months of their diagnosis, however, more than half of the ovarian cancer patients received pelvic imaging or CA-125 testing.1
"Our recommendation is that women with such symptoms have routine’ medical evaluation, since ovarian cancer is an uncommon condition and the same symptoms can occur in women without cancer," says Smith. "However, if the symptoms are not explained by such routine medical evaluation, or if they persist, then pelvic imaging and/or CA-125 should be considered."
One line of protection against ovarian cancer may come in the form of the birth control pill. Today’s low-dose combined oral contraceptives (OCs) are just as effective as older, high-dose formulations in protecting women from ovarian cancer.3
"Ever use of oral contraceptives reduces the risk of ovarian cancer by about 40%," says Roberta Ness, MD, MPH, professor of epidemiology, medicine, and obstetrics and gynecology and chair of the department of epidemiology at the University of Pittsburgh. The longer the use, the stronger the effect, she notes. "Protection from oral contraceptives lasts for up to 20 years after stopping the medication."
Progestins may play a role in OCs’ protective benefits. Research indicates that OCs with higher levels of progestin are associated with a greater reduction of ovarian cancer risk than those with a lower progestin dose.4 Findings also indicate that women who took pills with higher progestin levels showed a significant reduction in risk, even when the pills were taken for a short time.
References
- Smith LH, Morris CR, Yasmeen S, et al. Ovarian cancer: Can we make the clinical diagnosis earlier? Cancer 2005; 104: 1,398-1,407.
- American Cancer Society. How many women get ovarian cancer? Fact sheet. Accessed at: www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_women_get_ovarian_cancer_33.asp?sitearea=.
- Ness RB, Grisso JA, Klapper J, et al. Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. Am J Epidemiol 2000; 152:233-241.
- Schildkraut JM, Calingaert B, Marchbanks PA, et al. Impact of progestin and estrogen potency in oral contraceptives on ovarian cancer risk. J Natl Cancer Inst 2002; 94:32-38.
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