Predictive Value of Symptoms for Early Detection of Ovarian Cancer
Predictive Value of Symptoms for Early Detection of Ovarian Cancer
Background A recent consensus statement encouraged use of certain symptoms to diagnose ovarian cancer earlier. We assessed the sensitivity, specificity, and positive predictive value of a proposed symptom index and of symptoms included in the consensus recommendation.
Methods In-person interviews were conducted with 812 case patients, aged 35–74 years, who had epithelial ovarian cancer that was diagnosed from January 1, 2002, through December 31, 2005, and with 1313 population-based control subjects. The symptom index was considered positive when pelvic or abdominal pain or bloating or feeling full was reported at least daily for at least 1 week, with an onset of less than 12 months before diagnosis or a reference date (for control subjects). The consensus criteria were considered fulfilled when any symptom above or urinary urgency or frequency was reported for at least 1 month, with an onset of less than 12 months before diagnosis or a reference date. Positive predictive value was calculated by use of external estimates of cancer prevalence.
Results Most case patients who had a positive index or met consensus criteria did so only within 5 months before diagnosis. Symptoms (except nausea) were somewhat less likely to have occurred among women diagnosed with early-stage than late-stage ovarian cancer. The estimated positive predictive value of the symptom index or symptoms meeting the consensus criteria was 0.6%–1.1% overall and less than 0.5% for early-stage disease.
Conclusion Use of symptoms to trigger medical evaluation for ovarian cancer is likely to result in diagnosis of the disease in only one of 100 women in the general population with such symptoms.
In 2007, prompted by recent reports, the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society released a consensus statement on ovarian cancer symptoms (available at http://www.wcn.org/articles/types_of_cancer/ovarian/symptoms/concensus_statement.html). The statement notes that certain symptoms—including bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary urgency or frequency—are much more likely to be present in patients with ovarian cancer than in women in the general population and also that symptoms in women with ovarian cancer are persistent yet represent a change from an individual's normal baseline. The statement recommends that a woman who experiences the above-mentioned symptoms almost daily for more than a few weeks should consult her physician, with the hope that prompt evaluation may lead to earlier diagnosis of ovarian cancer and improved outcomes. The recommendation follows closely from the findings of Goff et al., who developed a "symptom index." The symptom index was considered positive when one or more symptoms (of pelvic or abdominal pain, increased abdominal size or bloating, and difficulty eating or feeling full) had been present for less than 1 year but for more than 12 days per month.
Concerns have been raised, however, regarding the ability of symptom recognition to result in detection of ovarian cancer at an earlier stage or to confer a survival benefit and the anticipated increases in associated health-care costs. The imperfect specificity of symptoms for detecting ovarian cancer and the relatively low prevalence of this disease indicate that most women with symptoms will not have ovarian cancer. In a large population-based study, we examined the occurrence and timing of symptoms in women with epithelial ovarian cancer and in control subjects. We assessed the sensitivity, specificity, and positive predictive value of approximations of Goff's symptom index and of symptoms included in the consensus recommendation.
Abstract and Introduction
Abstract
Background A recent consensus statement encouraged use of certain symptoms to diagnose ovarian cancer earlier. We assessed the sensitivity, specificity, and positive predictive value of a proposed symptom index and of symptoms included in the consensus recommendation.
Methods In-person interviews were conducted with 812 case patients, aged 35–74 years, who had epithelial ovarian cancer that was diagnosed from January 1, 2002, through December 31, 2005, and with 1313 population-based control subjects. The symptom index was considered positive when pelvic or abdominal pain or bloating or feeling full was reported at least daily for at least 1 week, with an onset of less than 12 months before diagnosis or a reference date (for control subjects). The consensus criteria were considered fulfilled when any symptom above or urinary urgency or frequency was reported for at least 1 month, with an onset of less than 12 months before diagnosis or a reference date. Positive predictive value was calculated by use of external estimates of cancer prevalence.
Results Most case patients who had a positive index or met consensus criteria did so only within 5 months before diagnosis. Symptoms (except nausea) were somewhat less likely to have occurred among women diagnosed with early-stage than late-stage ovarian cancer. The estimated positive predictive value of the symptom index or symptoms meeting the consensus criteria was 0.6%–1.1% overall and less than 0.5% for early-stage disease.
Conclusion Use of symptoms to trigger medical evaluation for ovarian cancer is likely to result in diagnosis of the disease in only one of 100 women in the general population with such symptoms.
Introduction
In 2007, prompted by recent reports, the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society released a consensus statement on ovarian cancer symptoms (available at http://www.wcn.org/articles/types_of_cancer/ovarian/symptoms/concensus_statement.html). The statement notes that certain symptoms—including bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary urgency or frequency—are much more likely to be present in patients with ovarian cancer than in women in the general population and also that symptoms in women with ovarian cancer are persistent yet represent a change from an individual's normal baseline. The statement recommends that a woman who experiences the above-mentioned symptoms almost daily for more than a few weeks should consult her physician, with the hope that prompt evaluation may lead to earlier diagnosis of ovarian cancer and improved outcomes. The recommendation follows closely from the findings of Goff et al., who developed a "symptom index." The symptom index was considered positive when one or more symptoms (of pelvic or abdominal pain, increased abdominal size or bloating, and difficulty eating or feeling full) had been present for less than 1 year but for more than 12 days per month.
Concerns have been raised, however, regarding the ability of symptom recognition to result in detection of ovarian cancer at an earlier stage or to confer a survival benefit and the anticipated increases in associated health-care costs. The imperfect specificity of symptoms for detecting ovarian cancer and the relatively low prevalence of this disease indicate that most women with symptoms will not have ovarian cancer. In a large population-based study, we examined the occurrence and timing of symptoms in women with epithelial ovarian cancer and in control subjects. We assessed the sensitivity, specificity, and positive predictive value of approximations of Goff's symptom index and of symptoms included in the consensus recommendation.
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