U.S. panel rejects ovarian cancer screening

Renewing prior recommendations, experts say current tests may do more harm than good.

16 april 2012-- A leading U.S. government panel has renewed its 2004 recommendation that women at average risk for ovarian cancer not get screened for the disease.

The currently used blood test and transvaginal ultrasound may cause more harm than benefit for those patients, according to draft recommendations issued Tuesday by the U.S. Preventive Services Task Force.

"Currently, the task force does not recommend screening for ovarian cancer," said Dr. David Grossman, a member of the task force and senior investigator with Group Health Research Institute in Seattle. "The tests that we have, unfortunately, just aren't very accurate and, with a lot of false positives, a lot of women get harmed with unnecessary biopsies and surgeries."

Women with a family history of ovarian cancer should be referred for genetic testing and counseling, the recommendations also state.

Two methods are currently used to test for ovarian cancer, a blood test which looks for the tumor marker CA-125 and a transvaginal ultrasound, Grossman explained.

However, a large study published last year found no difference in mortality between women who were randomly assigned to receive a blood test plus the ultrasound compared to those who had "usual care."

What's more, some 10 percent of women who underwent screening received a false-positive result and one-third of these had an ovary removed unnecessarily.

Another study estimated that 33 surgeries were needed to diagnose one case of ovarian cancer using the blood test/ultrasound screening.

Preliminary data from yet another trial, ongoing in the United Kingdom, also turned up false-positive results in about 10 percent of women undergoing screening. Half of those women had surgery and about 4 percent of these experienced a major complication from the surgery.

Like many screening tests, the blood test plus ultrasound for ovarian cancer "doesn't work, is potentially dangerous and also costs a lot of money," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.. "You're giving people a false sense of security, and it creates a lot of false positives which ultimately results in a lot of unnecessary surgeries."

Yet, many doctors still perform the tests because women demand it, Brooks noted.

With no new data affirming the benefit of CA-125 screening plus ultrasound, the new draft recommendations essentially reaffirm 2004 recommendations.

They are also in line with recommendations from the American Cancer Society and the American Congress of Obstetricians and Gynecologists (ACOG), Grossman said.

This leaves women with no good test to screen for ovarian cancer, considered a "silent killer" because symptoms are often noticed too late to be treatable.

"At the present, we do not have a good screening test for ovarian cancer," Brooks said.

And there are no other techniques on the horizon, Grossman added.

The draft recommendations will be posted on the task force website, and physicians and members of the public and of professional societies are invited to comment.

Final recommendations may be out in as soon as two months, Grossman said.

Ovarian Cancer Test Approved

14 sept 2009-- The U.S. Food and Drug Administration has approved a new test for women with pelvic tumors that are known to need surgery. The test, called OVA1, will help doctors decide if the tumor probably is ovarian cancer and how to proceed surgically.

OVA1 will identify some women who have negative results from ovarian cancer tests, but whose surgical cases would benefit from a gynecological oncologist's involvement, the agency said in a news release. Gynecological oncologists -- doctors who specialize in women's cancer -- have been found to help improve survival when they perform ovarian cancer surgery, the FDA said.

The new blood test -- approved for women aged 18 and older who have pelvic masses that require surgery -- is not meant to screen for ovarian cancer or replace diagnostics used to detect ovarian cancer, the FDA stressed.

OVA1 is produced by California-based Vermillion Inc., in conjunction with scientists at The Johns Hopkins University in Baltimore.

More information

The FDA has more about this approval.

Ovarian Cancer Is Not Always a 'Silent Killer'

Study finds that women sometimes report symptoms months before diagnosis

28 aug 2009- Despite the fact that ovarian cancer is dubbed the "silent killer," patients usually have symptoms that are noticeable, sometimes months before their diagnosis, according to a study published online Aug. 25 in BMJ.

William Hamilton, M.D., and colleagues at the University of Bristol in the United Kingdom analyzed medical records for 212 women over 40 years of age who were diagnosed with primary ovarian cancer, as well as 1,060 matched controls. Researchers blinded to the status of each patient assessed them for evidence of a range of reported symptoms.

There were seven symptoms reported by women that were associated with a subsequent diagnosis of ovarian cancer: abdominal distention, postmenopausal bleeding, loss of appetite, increased urinary frequency, abdominal pain, rectal bleeding and abdominal bloating, the researchers found. In 85 percent of the cases and 15 percent of the controls, at least one of these symptoms was reported to a primary care physician before diagnosis. After the symptoms reported within 180 days before diagnosis were excluded, abdominal distension, urinary frequency and abdominal pain were still independently associated with an ovarian cancer diagnosis.

"Currently, the only realistic proposition for expediting the diagnosis of ovarian cancer rests with identification of cancer in women with symptoms. Symptoms are common and often reported, even in early, and potentially curable, cancers. In that respect, our results are encouraging: there is some chance of identifying early ovarian cancer by using symptoms," the authors write. "Ovarian cancer is not silent; rather its sound is going unheard."

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Study Links Obesity to Ovarian Cancer

By RONI CARYN RABIN

07 jan 2009--Obese older women who never took postmenopausal hormones are at almost double the risk of developing ovarian cancer compared to their normal weight peers, a new study finds.

Among all older women, however, obese women were only at slightly higher risk for ovarian cancer than those of normal weight, the scientists found.

Researchers at the National Cancer Institute looked at differences among women who had never used hormone replacement therapy because it may play a role in the development of cancer. The comparison helps to tease out the effects of other risk factors, the authors said.

The study is to be published in the Feb. 15 issue of the journal Cancer.

The findings add to an ongoing scientific controversy over the potential association between body weight and ovarian cancer. “We speculate that what may be driving the increased risk among the obese is the surplus estrogen produced by the fat cells in the body,” said Dr. Michael F. Leitzmann, a former investigator at the National Cancer Institute and first author of the paper.

The epidemiological study looked at 94,525 women ages 50 to 71. Over a seven-year period, 303 of the women developed ovarian cancer. Overall, women who were obese, defined as having a body mass index of 30 or more, were 1.26 times more likely to have developed the cancer than those of normal weight, defined as having a B.M.I. under 25. That was a statistically insignificant difference, the researchers said.

But in a subgroup of women who had never used hormone replacement therapy, obese women were 1.83 times more likely to have developed the cancer than women of normal weight.

Among those who had taken hormones, there was no association between B.M.I. and ovarian cancer, the study found. B.M.I. was also not found to play a role in ovarian cancer risk for women with a family history of the disease.

Oral contraceptive use and having had children are associated with a decreased risk of ovarian cancer, while a family history of the disease and hormone therapy use are associated with an increased risk.

Earlier studies exploring the link between obesity and ovarian cancer have been inconsistent and contradictory, experts said, and this finding likely is not the last word on the matter.

A 2007 review of earlier clinical trials, called a meta-analysis, concluded that being overweight in adulthood was associated with a 16 percent increase in the risk of ovarian cancer, while being obese as an adult was linked to a 30 percent increase. But a pooled analysis published last year found that B.M.I. was tied to increased odds of ovarian cancer only in premenopausal women, who are at very low risk to begin with.

Lou Schouten, an author of the pooled analysis, noted in an e-mail message that questions about the association will linger. “This needs to be replicated in other populations (with lower proportions of postmenopausal hormone users) before we can decide whether this is a real and not a chance finding,” he said.

James V. Lacey Jr., an author of the new study, said that the earlier meta-analyses had included older data, yet more Americans are obese now and different disease risks may be emerging.

“It’s another piece of the puzzle,” he said.

Study Supports Cost-Effectiveness of Genetic Screening to Prevent Ovarian Cancer

Jacquelyn K. Beals, PhD

October 29, 2007 (San Diego) — Population testing of Ashkenazi Jewish (AJ) women for BRCA1/2 has the potential to prevent ovarian cancer (OC), prolong survival, and save nondiscounted costs of screening, according to an analysis presented here at the American Society of Human Genetics 57th Annual Meeting. Although current guidelines recommend BRCA1/2 testing if there is a positive family history, they do not recommend screening of all AJ women.
The poster cited studies showing that family history fails to identify half the women who carry the mutations and broke down the health and cost benefits of extending BRCA1/2 testing to the entire population of AJ women. Three founder mutations are responsible for 10% of breast cancers and 30% to 50% of OCs in this population.
Wendy S. Rubinstein, MD, PhD, FACMG, medical director, Center for Medical Genetics, Evanston Northwestern Healthcare Research Institute, Illinois, and lead author of the study, talked with Medscape Pathology about the decision analysis and its significance:
"If you start with an unselected group of women, you don't know what their family history is, but [if] they have ovarian cancer and they're Jewish, and then you test for the founder mutations, you'll find about 30% to 50% have that cancer due to an inherited tendency," said Dr. Rubinstein. "It's a very high proportion, it's not seen at that rate in very many other populations."
Values used for the decision analysis were drawn from research literature and included screening program participation rate, 0.9; mutation carrier rate in the population, 0.025; probability that a 40-year old carrier will follow up with a bilateral prophylactic salpingo-oophorectomy (BPSO), 0.50; probability that a mutation carrier will not get OC after PBSO, 0.96; probability that a mutation carrier will not get OC without PBSO, 0.84; probability that a noncarrier will develop OC, 0.016.
Additional parameters included in the analysis were the probability that women would get screening in the absence of a screening program and the proportion of carriers among women screened independently.
Dr. Rubinstein noted: "People that can find their way to clinics that do primary BRCA1/2 testing are knowledgeable. They usually have a high socioeconomic status, they usually have insurance, access to the types of screening that would be entailed to preventive measures. That means that there's a whole group of people who don't know, who aren't referred, and can't avail themselves of this.
"Education about your family history, that's where most people focus their efforts, and that's very appropriate," she continued. "The point is, that approach may miss a very significant number of individuals.... I don't know that it's a matter of access so much: Access implies that you know you have a problem but you can't get care for it. This is more an issue of awareness."
The analysis predicted that population-based BRCA1/2 screening in the AJ population would increase average survival by approximately 384 days for a 40-year old AJ woman BRCA1/2 carrier who had PBSO and would save about $100 in nondiscounted costs for each woman screened. The latter figure was based on the commercial cost of testing for the 3 founder mutations, $460; the cost of PBSO, $4622; the cost of OC treatments, $55,323; and the cost of follow-up care and last-year-of-life care.
Dr. Rubinstein commented on the challenges of dealing with health issues in a particular ethnic group: "The issue that I'm starting with is: Would it be cost effective to do this approach...would it save lives? It's very different than saying it should be done, because there are many other societal issues that have to be dealt with. When you're dealing with an ethnic group of any kind, you want them to have a stake in this rather than just saying "oh, yes, it's obvious this should be done."
Sharon Plon, MD, PhD, associate professor of pediatrics, director of Baylor Cancer Genetics Clinics and Neurofibromatosis Clinic, Texas Children's Hospital, Baylor College of Medicine, Houston, also talked with Medscape Pathology about population-based screening.
"It's a subject that I've studied for many years, and I think it's very important to really consider the ramifications of doing population-based screening...," Dr. Plon said. "Looking [at] the cost-effectiveness and some of the ongoing studies in Israel I think will hopefully get enough data to finally answer the question.... Even though those are not the current recommendations of the groups that put out guidelines..., I think that there [are] increasing data that it is probably worthwhile to do it."
Dr. Rubinstein reported an association with the speakers' bureau of Myriad Genetic Laboratories, Inc.
American Society of Human Genetics 57th Annual Meeting: Abstract 419/F. Presented October 26, 2007.

New Guidelines Should Improve Ovarian Cancer Detection

By Dennis ThompsonHealthDay ReporterSun Oct 28, 6:59 PM ET
SUNDAY, Oct. 28 (HealthDay News) -- Ovarian cancer has long had a reputation as a silent killer, because many people believed it gave no warning signs until far advanced.
But women suffering from the disease knew differently. They knew they had certain symptoms that were common from patient to patient.
"Survivors for years have said there are symptoms for the disease, but no one listened to them," said Jane Langridge, chief executive officer for the National Ovarian Cancer Coalition.
Now, doctors have agreed with them.
A screening test has been developed that, in one study, accurately detected early stage ovarian cancer 57 percent of the time.
Based on that and similar studies, experts from the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.
"We want people to know it's not the silent killer. There are symptoms women can bring to their doctors that are important to pay attention to," said Dr. Linda Duska, a member of the National Ovarian Cancer Coalition's medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center, in Boston.
"This agreement is significant in the fact that, maybe if we pay more attention to symptoms, we can catch them sooner and have more success in treating them," she continued.
Early detection of ovarian cancer is crucial.
More than 22,000 U.S. women will be diagnosed with the disease this year, and three-fourths of them -- more than 15,000 -- will die from it, according to the National Cancer Institute.
If caught in the early stages, the five-year survival rate for ovarian cancer is 90 percent. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.
Ovarian cancer is the eighth most common cancer among American women, not including skin cancer, according to the American Cancer Society. An estimated two-thirds of women with ovarian cancer are 55 or older.
"It is a disease that is detected in stage 3 and above, and that is unacceptable," said Sherry Salway Black, executive director of the Ovarian Cancer National Alliance and a survivor of the disease. "Our mortality figures are unacceptable."
The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders. They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate.
Because these symptoms are so common, women should be careful not to assume the worst, Duska said.
"The goal of this is not to make everyone think they have ovarian cancer," she said. "If women have these symptoms, and they persist over time, they should have them investigated. Everyone with bloating does not have ovarian cancer."
Typically, two or more symptoms occur simultaneously and increase in severity over time, according to the National Ovarian Cancer Coalition.
The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time. The test also produced "false-positive" findings 10 percent to 13 percent of the time.
The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.
"When women go to their doctors and have had some of these symptoms, and they are new and have persisted for two or more weeks, perhaps a doctor now would be willing to perform some pretty simple tests to rule out ovarian cancer," Langridge said.
Women who have a family history of breast or ovarian cancer are at increased risk and should pay particular attention to the symptoms, Duska said.
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Advances in chemotherapy have made the late-stage disease more survivable, Duska said.
In a more intensive regimen recently shown to improve survival, standard intravenous chemotherapy is combined with chemotherapy injected directly into the abdominal cavity. The abdominal injection exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.
"That was a breakthrough, I think," Duska said.
Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the body's own immune system to help combat cancer, according to the Mayo Clinic.
More information
To learn more about ovarian cancer, visit the U.S. National Library of Medicine.

Low-Fat Diet May Reduce Incidence of Ovarian Cancer in Postmenopausal Women

October 17, 2007 — A low-fat dietary pattern may reduce the incidence of ovarian cancer among postmenopausal women, according to the results of a study reported in the October 17 issue of the Journal of the National Cancer Institute.
"The Women's Health Initiative [WHI] Dietary Modification (DM) Randomized Controlled Trial evaluated the effects of a low-fat dietary pattern on chronic disease incidence, with breast cancer and colorectal cancer as primary outcomes," write Ross L. Prentice, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues. "The trial protocol also listed ovarian cancer and endometrial cancer as outcomes that may be favorably affected by the intervention."
From 1993 to 1998, 48,835 postmenopausal women were randomized to a DM intervention (n = 19,541) or to a usual diet (n = 29,294). Average follow-up was 8.1 years. The goal of the DM intervention was to decrease total fat intake to 20% of energy consumed and to increase intake of vegetables, fruits, and grains.
Pathology report review was used to confirm cancer outcomes, and weighted log-rank tests were used to compare between-group incidence of invasive cancers of the ovary and endometrium, total invasive cancer, and invasive cancers at other sites. All statistical tests were 2-sided.
Compared with the usual diet group, the DM intervention group had a lower risk for ovarian cancer (P = .03). Overall ovarian cancer hazard ratio (HR) was not statistically significantly less than 1.0, but the HR decreased with increasing duration of the DM intervention (P for trend = .01).
During the first 4 years, the risk for ovarian cancer was similar in both groups (0.52 cases per 1000 person-years in the intervention group vs 0.45 per 1000 person-years in the comparison group; HR, 1.16; 95% confidence interval [CI], 0.73 - 1.84). During the next 4.1 years, however, the risk was lower in the DM intervention group (0.38 cases per 1000 person-years in the intervention group vs 0.64 per 1000 person-years in the comparison group; HR, 0.60; 95% CI, 0.38 - 0.96).
Although the risk for endometrial cancer was not different between the groups (P = .18), the estimated risk for total invasive cancer was slightly lower in the intervention group vs the control group (HR, 0.95; 95% CI, 0.89 - 1.01; P = .10).
Limitations of the study include adjustment for multiple comparisons for risks for the 5 types of cancer studied in the trial, which may reduce the statistical significance of the findings; the lack of a consistent effect across the entire intervention period, reducing the certainty of an intervention effect; and the possibility that the cumulative hazard estimates could be distorted if ovarian cancers were detected earlier in the intervention group vs the comparison group.
"A low-fat dietary pattern may reduce the incidence of ovarian cancer among postmenopausal women," the study authors write. "The DM trial also suggests (P = .10) a possible reduction in total invasive cancer. Ongoing nonintervention follow-up of trial participants may provide additional valuable assessment of the effects of a low-fat dietary pattern on these and other cancer incidence rates."
The National Heart, Lung, and Blood Institute funded this study.
J Natl Cancer Inst. 2007;99:1534-1543.

Lancet Editorial Supports Ovarian Cancer Consensus Statement

A Lancet editorial supports the new ovarian cancer screening consensus statement that women who experience bloating, pelvic/abdominal pain, difficulty eating or feeling full quickly, or frequent or urgent urination for more than a couple of weeks should see their doctor, as these may be early symptoms of the disease.
While acknowledging that "such symptoms are ... associated with many other diseases and conditions, and for every ovarian cancer detected, many false positives might also result," the editorial points to recent research indicating that these symptoms are more severe and frequent in ovarian cancer.
Having also noted that the statement provides no guidance to physicians and that there's no evidence that use of these symptoms for screening will reduce mortality, the editorial concludes that it is a "move in the right direction" and that "its chief contribution might be to improve communication between women and their doctors."

Ovarian Cancer Not as Silent as Believed

NEW YORK, June 13 -- Ovarian cancer is associated with a specific set of symptoms that should trigger further evaluation by a physician, "preferably a gynecologist," according to a consensus statement released today. Although ovarian cancer is often not diagnosed until late stages because no disease-specific signs or symptoms had been previously identified, the statement urged that that a woman be evaluated if she has the nonspecific symptoms it cited "almost daily for more than a few weeks."
"Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies," said the statement. "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."
They are:
Bloating
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary symptoms (urgency or frequency).
"Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved diagnosis," according to statement issued by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society.
Only 19% of women with ovarian cancer are diagnosed at a stage when treatment has the best chance of extending survival beyond five years. According to the American Cancer Society 22,430 new cases of ovarian cancer and 15,280 deaths from ovarian cancer are likely this year in the United States.
The consensus statement also noted that although several other symptoms have been reported by women with ovarian cancer-notably fatigue, indigestion, back pain, pain with intercourse, constipation, and menstrual irregularities-those symptoms were judged to be not as useful in identifying ovarian cancer because they are also common among women without ovarian cancer.
The consensus statement was scheduled for release on June 25, but the contents of the statement were revealed in a front page article in today's New York Times.
Sherry Salway Black, executive director of the Ovarian Cancer National Alliance one of the groups that has endorsed the consensus statement, credited Barbara Goff, M.D., a University of Washington gynecologist, with much of the research that formed the basis for the statement.
Dr. Goff and Cindy Melancon, a co-founder of the Alliance, conducted a survey of ovarian cancer survivors aimed at pinpointing early symptoms. Those data were published in the Journal of the American Medical Association in 2004.
Black said the medical community has traditionally been dismissive of ovarian cancer patients' reports about symptoms. "We are proud that founders of the Ovarian Cancer National Alliance have been the catalyst for changing this thinking," she said. Primary source: Gynecologic Cancer Foundation, Society of Gynecologic Oncologists, American Cancer Society
Source reference: Goff BA et al "Frequency of symptoms of ovarian cancer in women presenting to primary care" JAMA 2004; 291: 2705-12

Early warning signs for ovarian cancer

By MIKE STOBBE, AP Medical WriterWed Jun 13, 4:41 PM ET
For the first time, cancer experts are advising women of certain symptoms that might alert them to ovarian cancer, a medically infamous "silent killer" that is hard to spot early and is one of the deadliest tumors.
Suddenly experiencing weeks of bloating, the need to urinate frequently, eating changes and abdominal or pelvic pain — either one of these or a combination — could be a tip-off to early ovarian cancer, according to several groups of cancer experts.
The American Cancer Society and other organizations released a consensus statement Wednesday listing the symptoms. Historically, doctors have believed there are no early signs of ovarian cancer, which is expected to kill about 15,000 American women this year.
"There's been this myth about ovarian cancer being silent and people saying there's nothing you can do about it. Well, that's simply not true anymore," said Dr. Barbara Goff, a University of Washington cancer specialist.
There is no early screening test; a regular pelvic exam is considered the main way to detect the cancer early.
The cancer society wrote the consensus statement along with the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists.
The experts say women should see their doctor if they suddenly experience any of these symptoms daily for at least three weeks:
_Bloating.
_Pelvic or abdominal pain.
_Difficulty eating or feeling full quickly.
_Frequent or urgent urination.
But the guidelines are problematic, said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.
Many women with these symptoms are more likely to have irritable bowel syndrome than ovarian cancer, she said. Also, there are no highly accurate tests to clearly confirm ovarian cancer at such an early stage.
That means pursuing the symptoms as a harbinger of ovarian cancer may, in some cases, lead to biopsies and other treatments that will do more harm than good.
"That was the frustration with this," Saslow said. But experts decided to issue the statement anyway, because important recent studies by Goff have indicated the sudden appearance of these symptoms in healthy women may be an important indicator.
Doctors said they expect media coverage of the guidelines will unleash a flood of queries from nervous women.
"I would expect an increase in calls from people wanting to come in and find out what is the cause of their symptoms. But if a patient is properly evaluated, it should not lead to an undue increase in diagnostic testing," said Dr. George Mussalli, chairman of the obstetrics and gynecology departments at St. Vincent's Hospital Manhattan.
Proper evaluation includes asking whether a woman has a family history of breast or ovarian cancer or has tested positive for a genetic mutation associated with those conditions, said Jane Langridge, who heads the National Ovarian Cancer Coalition, an advocacy group.
Women should initially be evaluated by a gynecologist, but they should go to a specialist in gynecologic cancers if more testing and treatment is contemplated, she added.
Doctors check for ovarian cancer with ultrasound, a blood test and an exam in which a doctor feels for a mass. Unfortunately, none are considered highly accurate. The blood test — which checks for a protein that can indicate ovarian cancer — is particularly problematic, some doctors said.
"In premenopausal women, it's almost useless. So many other factors can elevate it," said Dr. Stuart Pancer, an obstetrician/gynecologist at DeKalb Medical, an Atlanta-area hospital system.
Still, Pancer and others said it's important that more women and their doctors practice vigilance.
"We hope this is going to save lives," Goff said.
Among cancers, ovarian is the fifth leading killer of women. It accounts for about 6 percent of female cancer deaths, according to the American Cancer Society.
Lung cancer is No. 1, accounting for more than a quarter of all female cancer deaths. Cancers of the breast, colon and rectum, and pancreas also kill more women.
Survival rates vary by age: Women younger than 65 are about twice as likely to survive at least five years after diagnosis. The overall survival rate is 76 percent after one year and 45 percent after five years.
Survival rates are much higher if the cancer is caught at an early, localized stage, but only one in five ovarian cancers are detected at that point, according to the cancer society.
___
AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

Symptoms Found for Early Check on Ovary Cancer

By DENISE GRADY
Cancer experts have identified a set of health problems that may be symptoms of ovarian cancer, and they are urging women who have the symptoms for more than a few weeks to see their doctors.
The new advice is the first official recognition that ovarian cancer, long believed to give no warning until it was far advanced, does cause symptoms at earlier stages in many women.
The symptoms to watch out for are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and feeling a frequent or urgent need to urinate. A woman who has any of those problems nearly every day for more than two or three weeks is advised to see a gynecologist, especially if the symptoms are new and quite different from her usual state of health.
Doctors say they hope that the recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives, or at least prolong survival.
But it is too soon to tell whether the new measures will work or whether they will lead to a flood of diagnostic tests or even unnecessary operations.
Cancer experts say it is worth trying a more aggressive approach to finding ovarian cancer early. The disease is among the deadlier types of cancer, because most cases are diagnosed late, after the cancer has begun to spread.
This year, 22,430 new cases and 15,280 deaths are expected in the United States.
If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early, and 45 percent of all women with the disease survive at least five years after the diagnosis.
By contrast, among women with breast cancer, 89 percent survive five years or more.
The new recommendations, expected to be formally announced on June 25, are being made by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.
More than 12 other groups have endorsed them, including CancerCare; Gilda’s Club, a support network for anyone touched by cancer; and several medical societies.
“The majority of the time this won’t be ovarian cancer, but it’s just something that should be considered,” said Dr. Barbara Goff, the director of gynecologic oncology at the University of Washington in Seattle and an author of several studies that helped identify the relevant symptoms.
In a number of studies by Dr. Goff and other researchers, these symptoms stood out in women with ovarian cancer as compared with other women.
“We don’t want to scare people, but we also want to arm people with the appropriate information,” said Dr. Goff, who is also a spokeswoman for the Gynecologic Cancer Foundation.
She emphasized that relatively new and persistent problems were the most important ones. So, the transient bloating that often accompanies menstrual periods would not qualify, nor would a lifelong history of indigestion.
Dr. Goff also acknowledged that the urinary problems on the list were classic symptoms of bladder infections, which is common in women. But it still makes sense to consult a doctor, she said, because bladder infections should be treated. Urinary trouble that persists despite treatment is a particular cause for concern, she said.
With ovarian cancer, even a few months’ delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs, Dr. Goff said.
“If you let it go for three months, you can wind up with disease everywhere,” she said
Dr. Thomas J. Herzog, director of gynecologic oncology at the Columbia University Medical Center, said the recommendations were important because the medical profession had until now told women that there were no specific early symptoms.
“If women were more pro-active at recognizing these symptoms, we’d be better at making the diagnosis at an earlier stage,” Dr. Herzog said.
“These are nonspecific symptoms that many people have,” he added. “But when the symptoms persist or worsen, you need to see a specialist. By no means do we want this to result in unnecessary surgery. But I would not expect that to occur in the vast majority of cases.”
Although the American Cancer Society agreed to the recommendations, it did so with some reservations, said Debbie Saslow, director of breast and gynecologic cancer at the society.
“We don’t have any consensus about what doctors should do once the women come to them,” Dr. Saslow said. “There was a lot of hope that we’d be able to say, ‘Go to your doctor, and they will give you this standardized work-up.’ But we can’t do that.”
At the same time, Dr. Saslow said, the cancer society recognized that in some cases doctors had disregarded symptoms in women who were later found to have ovarian cancer, telling the women instead that they were just growing old or going through menopause.
“There are so many horror stories of doctors who have told women to ignore these symptoms or have even belittled them on top of that,” Dr. Saslow said.
In a survey of 1,700 women with ovarian cancer, Dr. Goff and other researchers found that 36 percent had initially been given a wrong diagnosis, with conditions like depression or irritable bowel syndrome.
“Twelve percent were told there was nothing wrong with them, and it was all in their heads,” Dr. Goff said.
Dr. Goff and other specialists said women with the listed symptoms should see a gynecologist for a pelvic and rectal examination. (The best way for a doctor to feel the ovaries is through the rectum.) If there is a question of cancer, the next step is probably a test called a transvaginal ultrasound to check the ovaries for abnormal growths, enlargement or telltale pockets of fluid that can signal cancer. The ultrasound costs $150 to $300 and can be performed in a doctor’s office or a radiology center. A $100 blood test should also be conducted for CA125, a substance called a tumor marker that is often elevated in women with ovarian cancer.
Cancer specialists say any woman with suspicious findings on the tests should be referred to a gynecologic oncologist, a surgeon who specializes in cancers of the female reproductive system.
An unresolved question is what exactly should be done if the test results are normal and yet the woman continues to have symptoms, Dr. Saslow said.
“Do you do exploratory surgery, which has side effects, which are sometimes even fatal?” she asked. “What do you do? We don’t have the answer to that.”
Depending on the test results, the woman may just be monitored for a while or advised to undergo a CT scan or an MRI. But if cancer is strongly suspected, she will probably be urged to go straight to surgery. A needle biopsy, commonly used for breast lumps, cannot be safely performed to check for ovarian cancer because it runs a risk of rupturing the tumor and spreading malignant cells in the abdomen. Instead, the surgeon must carefully remove the entire ovary or the abnormal growth on it and examine the rest of the abdomen for cancer.
While the patient is still on the operating table, biopsies are performed on the tissue that was removed, so that if cancer is found, the surgeon can operate more extensively. Experts say such an operation should be carried out just by gynecologic oncologists, who have special training in meticulously removing as much of the cancerous tissue as possible. This procedure, called debulking, lets chemotherapy work better and greatly improves survival.
Dr. Carol L. Brown, a gynecologic oncologist at the Memorial Sloan Kettering Cancer Center in Manhattan, said, “Ideally, we need to develop a screening tool or a test to find ovarian cancer before it has symptoms.”
No such screening test exists, Dr. Brown said, and until one is developed, the list of symptoms may be the best solution.
“This is something that women themselves can do,” she added, “and we can familiarize clinicians with, to help make the diagnosis earlier.”

Combining PET, CT Scans Can Improve Ovarian Cancer Care

Combining positron emission tomography (PET) and CT scans can help doctors detect more sites of disease in women with recurrent ovarian cancer, identify those patients whose cancer is likely to progress, and influence doctors' management of most patients.
That's the finding from an Australian study of 90 women.
"PET/CT -- using fluorodeoxyglucose or FDG -- detected many more sites of disease than were found with routine imaging both within and outside the abdomen," Michael J. Fulham, professor and clinical director of medical imaging at Sydney South West Area Health Service and head of the department of PET and nuclear medicine at Royal Prince Alfred Hospital in Sydney, said in a prepared statement.
"PET/CT influenced treatment decisions in 59 percent of the 90 women and identified those whose disease was more likely to progress within 12 months," he noted.
"Our findings also suggest that there is an opportunity for technology replacement -- replacing routine CT of the abdomen and pelvis -- with PET/CT with the radiotracer FDG, thus reducing costs and providing better answers for patients and referring doctors."
The study was to be presented at the Society of Nuclear Medicine's annual meeting in Washington, D.C., June 2-6.
"The next step in this research will be to attempt to identify those patients with residual disease after initial diagnosis and treatment has been completed -- with the hope of positive outcomes for more patients by identifying those with residual active disease much earlier on," Fulham said.

Ultrasound screening may catch ovarian cancer early

A new study suggests that ovarian cancer screening with a technique called transvaginal ultrasonography (TVS) may catch ovarian cancer early, at a more curable stage.
TVS involves using an ultrasound probe placed in the vagina to direct sound waves through the vaginal wall towards the ovaries to detect abnormalities. The new study shows that TVS screening is able to detect ovarian cancers at an earlier stage, perhaps increasing their chances of survival.
The early diagnosis of ovarian cancer is difficult and the disease is often not detected until it has reached an advanced stage. Compared with other gynecologic cancers, ovarian cancer carries a very poor prognosis.
Dr. John R. van Nagell, from the University of Kentucky in Lexington, and colleagues assessed the value of annual TVS screening for ovarian cancer in 25,327 women who were seen between 1987 and 2005.
To be eligible for the study, the women had to be at least 50 years old with no cancer-related symptoms or at least 25 years old with a family history of ovarian cancer.
Overall, 364 women (1.4 percent) had a persistent ovarian tumor on TVS, the authors report in the journal Cancer. Malignant cases included 35 primary invasive ovarian cancers, 9 ovarian tumors of low malignant potential, and 7 "metastatic" cancers that had already spread beyond the ovaries. Most of the contained or "non-metastatic" ovarian tumors were early stage I tumors.
During an average follow-up of about 5 years, 38 women were alive and well, 4 had died of their cancer, and 2 had died from other causes.
The 2-year survival rate in annually TVS screened women approached 90 percent and the 5-year survival rate in screened women was a little over 77 percent.
TVS screening was highly sensitive and specific in detecting ovarian cancer. However, "false-negative" results were obtained in nine women, including three who died of their disease, the investigators note.
Summing up, the researchers say early detection of ovarian cancer could potentially improve treatment efficacy and reduce deaths. "The protective effect of annual sonographic screening on ovarian cancer mortality observed in the current trial should only increase as more specific biomarkers are added to TVS in screening algorithms," they conclude.
SOURCE: Cancer, May 1, 2007.

One Women In Three Under-Treated For Ovarian Cancer

SEATTLE, April 9 -- One in three American women with ovarian cancer may not get the recommended comprehensive surgical treatment, according to researchers here.
An analysis of hospital data from nine states shows that 66.9% of all women admitted with a diagnosis of ovarian cancer got optimal treatment, reported Barbara Goff, M.D., of the University of Washington, and colleagues, in the May 15 issue of Cancer.
Women who were 71 or older, of African-American race, or Hispanic ethnicity or covered by Medicaid were most likely to be under-treated, Dr. Goff and colleagues said.
On the other hand, the analysis showed, women cared for by surgeons with a high volume of ovarian cancer treatment -- defined as 10 or more cases a year -- were more likely to get appropriate therapy, the researcher said.
The findings bolster the argument that all women with ovarian cancer should be sent to specialist centers for their surgical care, the researchers said.

http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb1/5407