Symptoms aren't always effective in diagnosing early ovarian cancer, study finds

Using symptoms such as bloating and pelvic pain is not effective for early diagnosis of ovarian cancer, according to a recent study.

A 2007 consensus statement from the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society recommended that women experiencing daily physical symptoms such as bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary frequency or urgency for more than a few weeks see a physician for evaluation for ovarian cancer. The statement was based on a symptom index proposed by an earlier study, which was considered positive when patients had at least one of several symptoms (pelvic or abdominal pain, increased abdominal size or bloating, and difficulty eating or feeling full) for less than a year but for more than 12 days a month. Researchers performed a population-based study to determine the sensitivity, specificity and positive predictive value of a symptom index and of the symptoms noted in the recommendation statement. The study results were published online Jan. 28 and will appear in the Feb. 24 Journal of the National Cancer Institute.

The authors interviewed 812 patients with epithelial ovarian cancer diagnosed between Jan. 1, 2002, and Dec. 21, 2005, and 1,313 population-based controls. The symptom index was considered positive when a woman had pelvic or abdominal pain, bloating, or feeling full daily for a least a week beginning less than a year before diagnosis or, for controls, a reference date. The consensus statement criteria were considered positive if a woman had any of these symptoms or urinary urgency or frequency for at least a month beginning less than a year before diagnosis or a reference date. Although patients with ovarian cancer were much more likely than those without to experience the index and consensus statement symptoms, these indicators were positive only within five months before diagnosis in most cases. The symptom index and consensus criteria were estimated to have a positive predictive value of less than 0.5% for early-stage disease and 0.6% to 1.1% overall.

The authors acknowledged several study limitations, including recall bias and the possibility that women with aggressive disease were not able to be interviewed. However, they concluded that evaluating patients for ovarian cancer based on physical symptoms is unlikely to lead to timely diagnosis. An accompanying editorial also noted the study's limitations and pointed out that patients with ovarian cancer were 10 times more likely to have symptoms than those without. Still, the editorialists wrote, "These findings remind us that wide recognition of symptoms alone will not incrementally improve the overall survival from ovarian cancer. Rather, they highlight the urgent need to develop better molecular markers and improved imaging modalities for ovarian cancer screening."