Symptom screening plus a simple blood test improves early detection of ovarian cancer

Women's reports of persistent, recent-onset symptoms linked to ovarian cancer – abdominal or pelvic pain, difficulty eating or feeling full quickly and abdominal bloating – when combined with the CA125 blood test may improve the early detection of ovarian cancer by 20 percent, according to new findings by researchers at Fred Hutchinson Cancer Research Center published online today in CANCER.

Research has found that when used alone, a simple four-question symptom-screening questionnaire and the CA125 ovarian-cancer blood test each detect about 60 percent of women with early-stage ovarian cancer and 80 percent of those with late-stage disease. This study found that when used together, the questionnaire and blood test may boost early-detection rates to more than 80 percent and late-stage detection rates to more than 95 percent.

"Of course, it is the increase in the detection of early-stage disease that is the most exciting," said lead author M. Robyn Andersen, Ph.D., an associate member of the Public Health Sciences Division at the Hutchinson Center. Cure rates for those diagnosed when the disease is confined to the ovary are approximately 70 percent to 90 percent. However, more than 70 percent of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20 percent to 30 percent.

"This research suggests that if a woman has one or more symptoms that are new for her, having begun within the past year, and if the symptoms happen nearly daily or at least 12 times a month, that may well be a signal to go in and discuss those symptoms with her doctor," Andersen said. "It's probably not going to be ovarian cancer, just as most breast lumps are not breast cancer, but it's still a sign that it might be worth checking with her doctor to see if a CA125 blood test and transvaginal ultrasound may be appropriate."

Assessing the symptoms included in the symptom-screening index may already be done by some doctors based on a consensus statement issued last year by the National Institutes of Health. The researchers hope their symptom index will help doctors know which among their patients who complain of symptoms such as abdominal swelling and pelvic pain might have cancer.

The symptom-screening index, developed in 2006 by paper co-author Barbara A. Goff, M.D., professor and director of Gynecologic Oncology at the University of Washington School of Medicine, is not used proactively in clinical general practice, but Andersen and colleagues are conducting a pilot study to assess the value of using it as a screening tool among normal-risk women as part of their routine medical-history assessment.

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For the just-published study, the researchers administered the symptom questionnaire to 75 women about to undergo surgery for pelvic masses who were later diagnosed with ovarian cancer (the case group), and 254 healthy women at high risk for ovarian cancer due to a family history of the disease (the control, or comparison, group). The cases were recruited through Pacific Gynecology Specialists at Swedish Medical Center in Seattle, and the controls were recruited through the Ovarian Cancer Early Detection Study, a joint project of the Hutchinson Center and the Marsha Rivkin Center for Ovarian Cancer Research.