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The Lancet Oncology, Early Online Publication, 17 January 2012
doi:10.1016/S1470-2045(11)70405-3
Early detection of ovarian cancer in symptomatic women
"Since Goff and co-workers1 first reported that many women with ovarian cancer have symptoms of abdominal bloating, early satiety, pelvic pain, and urinary urgency, frequency, or both, questions have arisen as to whether assessment of these symptoms could lead to earlier detection of this cancer. The Diagnosing Ovarian Cancer Early (DOvE) pilot project reported in The Lancet Oncology by Gilbert and co-workers2 seeks to answer this question. Clinical examination, measurement of CA-125 concentrations in serum, and transvaginal ultrasonography (TVUS) were used in 1455 women older than 50 years who had symptoms associated with ovarian cancer. 11 ovarian cancers were detected, which yielded a prevalence of one per 132 women (0·76%), or about ten times that observed in screening studies in the USA, UK, and Japan.3—5."
"Whether assessment of symptomatic women with multiple methods will lead to detection at earlier stages or increase survival needs to be tested in larger numbers of cases. That the assessment algorithm used in the DOvE project identified most patients with symptomatic ovarian cancer when their disease was still resectable, however, is encouraging. Optimum cytoreduction is associated with a notable survival advantage in patients with ovarian cancer, and was achieved in eight (73%) of 11 women in the study group versus 33 (44%) of 75 women in a control group of patients with ovarian cancer who had been referred to a local gynaecological oncology clinic (p=0·075). The degree of cytoreduction, however, also depends on factors other than tumour burden, including the location of disease and experience of the surgeon. To continue this project beyond the pilot phase, it will be important to document disease substage and note tumour volume before debulking (in study and control cases) to establish whether assessment-driven interventions affect tumour burden. Although the DOvE algorithm successfully identified 11 cases of ovarian cancer, 1444 (99.2%) symptomatic women did not have ovarian cancer. In the next phase of this study, the positive and negative predictive values of each symptom must be critically assessed to identify the profile of highest risk. Additionally, the duration of symptoms before ovarian cancer detection should be recorded for the study and control populations. In this way, it should be possible to investigate whether a public education campaign alters the time from symptom onset to detection of disease in patients with ovarian cancer."
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"Whether assessment of symptomatic women with multiple methods will lead to detection at earlier stages or increase survival needs to be tested in larger numbers of cases. That the assessment algorithm used in the DOvE project identified most patients with symptomatic ovarian cancer when their disease was still resectable, however, is encouraging. Optimum cytoreduction is associated with a notable survival advantage in patients with ovarian cancer, and was achieved in eight (73%) of 11 women in the study group versus 33 (44%) of 75 women in a control group of patients with ovarian cancer who had been referred to a local gynaecological oncology clinic (p=0·075). The degree of cytoreduction, however, also depends on factors other than tumour burden, including the location of disease and experience of the surgeon. To continue this project beyond the pilot phase, it will be important to document disease substage and note tumour volume before debulking (in study and control cases) to establish whether assessment-driven interventions affect tumour burden. Although the DOvE algorithm successfully identified 11 cases of ovarian cancer, 1444 (99.2%) symptomatic women did not have ovarian cancer. In the next phase of this study, the positive and negative predictive values of each symptom must be critically assessed to identify the profile of highest risk. Additionally, the duration of symptoms before ovarian cancer detection should be recorded for the study and control populations. In this way, it should be possible to investigate whether a public education campaign alters the time from symptom onset to detection of disease in patients with ovarian cancer."
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