Sunday, September 26, 2010
part 111: International patient charters are often nonbinding or feature fuzzy metrics -- Canadian Medical Association Journal (patient charter of rights)
Last of a three-part series on patient charters
Part I: Patients charters: the provincial experience (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3339)
Part II: Patient charters all buzz and no bite, advocates say (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3340)
Abstract: Ovarian cancer is a heterogeneous, rapidly progressive, highly lethal disease of low prevalence. The etiology remains poorly understood. Numerous risk factors have been identified, the most prominent involving an inherited predisposition in 10% of cases. Women with germline mutations associated with Hereditary Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated risks (up to 46% and 12%, respectively). Risk-reducing salpingo-oophorectomy is the best method to prevent ovarian cancer in these high-risk women. Significant risk reduction is also seen in the general population who use oral contraceptives. Since up to 89% patients with early-stage disease have symptoms prior to diagnosis, increased awareness of the medical community may facilitate further workup in patients who otherwise would have had a delay. Despite enormous effort, there is no proof that routine screening for ovarian cancer in either the high-risk or general populations with serum markers, sonograms, or pelvic examinations decreases mortality. Further evaluation is needed to determine whether any novel biomarkers, or panels of markers, have clinical utility in early detection. Prospective clinical trials have to be designed and completed prior to offering of any of these new diagnostic tests. CA125 is currently the only biomarker recommended for monitoring of therapy as well as detection of recurrence. This commentary provides an overview on the background, screening and surveillance of ovarian cancer.
Detecting ovarian cancer in primary care
• Refer urgently if physical examination identifies a pelvic or abdominal mass and/or ascites.
• Investigate if a woman reports any of the following more than 12 times a month: abdominal distension, difficulty eating and/or feeling full, pelvic or abdominal pain or increased urinary urgency and/or frequency
• Also consider testing woman with abnormal vaginal bleeding, unexplained weight loss, abdominal distension, fatigue or changes in bowel habit.
• Send women with a serum CA125 35 IU/ml for an ultrasound scan and refer with a positive scan urgently for further investigation.
• Advise any woman who has normal serum CA125, or a normal ultrasound, to return to her GP for re-assessment if her symptoms persist or become more frequent.
Source: The recognition and initial management of ovarian cancer, draft NICE guideline, September 2010