Indexing Ovarian Cancer Symptoms - How Valuable Are They

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Academic Journal
Main Category: Ovarian Cancer
Article Date: 13 Jan 2012 - 13:00 PST

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A study published January 13 in the Journal of the National Cancer Institute reveals that in the UK and the U.S., symptom indices used to identify individuals with symptoms connected with ovarian cancer who may need additional screening is on the rise, however, in order to help better detect cancer they may need to be reevaluated.

Often symptoms of ovarian cancer go undetected until the disease has reached an advanced stage and has spread to other areas of the body. According to some evidence, patient-reported symptoms could help detect the disease at an early stage, and the Goff index, which uses questionnaire data, has been shown to be effective in identifying those at low to moderate risk of developing the disease. Although, symptom evaluation may significantly influence index performance.

Anita Wey Wey Lim of the Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, at Queen Mary University of London and colleagues, set out to determine the effectiveness of the symptom indices by examining data from 268 control participants who underwent ovarian cancer screening and 194 women who had recently been diagnosed with the disease.

The researchers examined the symptom data through general practitioner notes, questionnaires and telephone interviews. In addition, the team also determined the sensitivity of the symptoms reported within a few months of the diagnosis by comparing two 12 month periods (0-11 and 3-14 months prior to diagnosis).

Results from the analysis were comparable to results found in previous studies on the Goff index. In addition they found that the sensitivity of the symptoms was stronger in advanced stages of ovarian cancer than in early stages.

Furthermore, the team found there is only a slight difference in the symptoms women with early stage disease reported than those with late-stage disease.

The researchers explain: "The small differences between the three indices indicate that there is little to gain from deriving new symptom indices." They suggest that although a symptom index may help diagnose the disease, the benefits are significantly overemphasized, as the majority of ovarian cancer symptoms appear within three months prior to diagnosis.

They said:

"At best, a symptom index might advance diagnosis of ovarian cancer by 3 months or more in two-thirds of women. For a more specific index, the sensitivity would be approximately one-third."

In an associated report, Patricia Hartge, ScD, at National Cancer Institute's Division of Cancer Epidemiology and Genetics, and James L. Speyer, MD, from the NYU Langone Cancer Center, explain that symptom indices described in the investigation are seen as good for identifying early-stage ovarian cancer in women with the belief that early detected and treatment can produce a better patient outcome.

While this can be true, Hartge and Speyer warn that these indices were not highly specific and that cancer symptoms were detected around the time the individual was diagnosed.

They explain:

"The study design permits no calculation of years of life that might have been saved or lost if screeners actually were used - only a large and expensive randomized trial would do that - but clinical gains likely would be minor and many women would undergo unnecessary diagnostic procedures to assure that they are cancer free. The biology of ovarian cancer, the arithmetic of screening, and the clinical characteristics of the disease and its treatment collude to make it difficult to find ovarian cancer early enough to matter."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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