The use of symptom indices to identify patients with symptoms associated with ovarian cancer who may need further screening is increasing in both the UK and the US in an attempt to promote earlier diagnosis, but these indices may need to be reassessed in order to help better detect cancer, according to a study published January 13 in the Journal of the National Cancer Institute.
In an accompanying editorial, Patrician Hartge, ScD, of the National Cancer Institute, wrote that that study, conducted by Anita Wey Wey Lim at the Queen Mary University of London, revealed that “symptom indices as ovarian cancer screeners can be sensitive to the presence of ovarian cancer in the period between 3 and 14 months before clinical diagnosis. On the other hand, they were not highly specific because a substantial fraction of women without disease registered as positive. Furthermore, these attractively simple screeners showed a disappointing capacity to find cancer early, largely because the symptoms arose close to the time of diagnosis.”
For doctors who use a symptom index in an effort to screen for ovarian cancer, this study suggests that revisions and modifications to existing questionnaires would have only a minor impact on their ability to distinguish the small number of women with silent ovarian cancer from the vast number of cancer-free women. Instead, she suggests that “the relationship between the symptom index and CA-125 and HE4 warrants investigation,” to find the right combination of screening questionnaires, blood tests, and imaging that would perhaps be more useful.
Dr. Hartge writes that ultimately, “detecting ovarian cancer at an earlier time but when the patient is already symptomatic is unlikely to make a major difference in outcome,” and that “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.” Instead, she suggests that further research to understand the origins of the disease, as well as to better prevent and treat it, are critical as physicians seek to find ways to prevent deaths from ovarian cancer.
Lim AW, Mesher D, Gentry-Maharaj A, Balogun N, Jacobs I, Menon U, Sasieni P. Predictive Value of Symptoms for Ovarian Cancer: Comparison of Symptoms Reported by Questionnaire, Interview, and General Practitioner Notes. J Natl Cancer Inst. 2012 Jan 13. [Epub ahead of print] PubMed PMID: 22247022.