By Rose Hoban
Chapel Hill, NC
15 December 2006

Obstetrician and gynecological surgeon Barbara Goff used to subscribe to the conventional medical wisdom that there are few early symptoms of ovarian cancer. But she changed her mind a few years ago, after a meeting with ovarian cancer survivors who told her they'd all had early symptoms of the disease. They urged her to follow up on their experiences, and she recalls thinking, "Wow, you know, maybe there's something here, in this symptom thing!"

Goff emphasizes the importance of finding ovarian cancer as soon as possible. "The cure rates for women with early-stage disease are 70 to 90 percent, where for most women who present to late-stage disease, the cure rates are only 10 to 30 percent, at best."

Barbara Goff has now completed her third study, surveying thousands of women in the process. She and her research team have been able to identify six symptoms that seem to be strong indicators of early stage ovarian cancer: pelvic or abdominal pain, abdominal bloating or increased abdominal size and difficulty eating and feeling full quickly. "When… any of those symptoms occurred with a frequency of at least 12 times per month and they had been present for less than a year," Goff explains, "these symptoms were actually predictive of women who had cancer."

Ovarian cancer causes more deaths than any other gynecological cancer. And currently there's only one blood test that can indicate its presence at an early stage. Goff says that using her symptom index is just as predictive as the blood test in detecting the disease. And more importantly, she adds, it's less expensive. "It doesn't cost anything to ask somebody about what symptoms they've had," she points out, "unlike a blood test or an ultrasound or a radiographic study. That costs money and sometimes those studies are uncomfortable, sometimes they can carry some risk associated with them. But this is no risk and really almost no cost, which is what's great about it."

Barbara Goff says the next step is to have primary care doctors use her symptom index in regular practice to confirm its accuracy. The research appears in the current on-line issue of the journal Cancer.

Symptom screening advances early ovarian cancer detection

Published: Dec 11, 2006

A symptom survey may provide clinicians with a rapid, cost-effective screening tool to detect early stages of ovarian cancer, according to a new study. Published in the January 15, 2007 issue of CANCER (http://www.interscience.wiley.com/cancer-newsroom), a peer-reviewed journal of the American Cancer Society, the study reveals that early ovarian cancer may be distinguished from other causes by a specific set of symptoms and their frequency and duration.

Physicians generally consider ovarian cancer to be a "silent killer." That is, it develops asymptomatically or with symptoms easily attributable to benign causes until diagnosed late in the course of disease and well after a cure is likely. There is no effective screening test to detect early stage disease in the general population or even high-risk groups. Consequently, no professional gynecology association or public health agency recommends routine screening. Also, the lack of recognized, early clinical signs and symptoms delays diagnosis until advanced disease. These factors combine to make ovarian cancer one of the deadliest malignancies in the world.

Recent evidence suggests that early-stage symptoms may be recognizable and could be used to develop a symptom index for early disease. Led by Barbara A. Goff, M.D. of the University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center in Seattle, researchers compared the clinical history of women at high risk for developing ovarian cancer and women already diagnosed with ovarian cancer to develop a basic symptom index to screen for ovarian cancer.

They found "that a relatively simple evaluation of symptoms of recent onset and significant frequency" was sufficient to be a potential screening tool. Any complaint of pelvic/abdominal pain, increased abdominal size/bloating, or difficulty eating/feeling full that is present more than 12 days per month and for less than one year was 57 percent sensitive for early disease and 80 percent sensitive for advanced cancer; and 90 percent specific for women over 50 years of age and 86.7 percent for women under 50 years of age.

While Dr. Goff plans on evaluating a simple three question screening in a multi-year study in general clinical practice, "a symptom index, though, is only one of a number of promising research tracks the ovarian cancer advocacy community actively supports," writes Sherry Salway Black, Executive Director of the Ovarian Cancer National Alliance in Washington, D.C. in an accompanying editorial from the same issue. Although years away, the development of a screening blood test would be "the real key to early detection." She continues, "until there is a valid screening test, the symptom index could serve an important role in detecting cancers, and after a test is identified, the index could be a tool used in combination with other methods to contribute to early detection." In the meantime, according to Ms. Salway Black, health organizations will continue to educate women and physicians about "the symptoms so that if cancer develops, it is diagnosed early" because "at present, awareness of these symptoms is our best hope for early detection."