Symptoms experienced by women that are more severe or frequent than expected and of recent occurrence warrant further diagnostic investigation because they are more likely to be associated with either benign or malignant ovarian masses, according to an article in the June 9th issue of The Journal of the American Medical Association.

"Ovarian cancer has often been called the 'silent killer' because symptoms are not thought to develop until advanced stages when chance of cure is poor," the authors write as background information in the article. Previous research had found that "80 percent to 90 percent of women with early stage disease will report symptoms for several months prior to diagnosis." The authors continued, "Identification of early symptoms may have important clinical implications because 5-year survival for early stage disease is 70 percent to 90 percent compared with 20 to 30 percent for advanced-stage disease."

In the study, Barbara A. Goff, MD, and her colleagues compared the frequency, severity, and duration of symptoms between women with ovarian masses (n=128) and control women who visited two primary care clinics (n=1,709). The women were asked to complete a survey of symptoms experienced over the past year (July 2001 - January 2002). Severity of symptoms was rated on a 5-point scale, duration was recorded, and frequency was indicated as number of episodes per month.

"In the clinic population, 72 percent of women had recurring symptoms, with a median number of two symptoms. The most common were back pain (45 percent), fatigue (34 percent), bloating (27 percent), constipation (24 percent), abdominal pain (22 percent), and urinary symptoms [urgency/frequency] (16 percent)," the researchers found.

"Comparing ovarian cancer cases to clinic controls resulted in an [increased] odds ratio of 7.4 for increased abdominal size; 3.6 for bloating; 2.5 for urinary urgency; and 2.2 for pelvic pain. Women with malignant masses typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or controls. The combination of bloating, increased abdominal size, and urinary symptoms was found in 43 percent of those with cancer but in only 8 percent of those presenting to primary care clinics."

"While our current study did find that women who present to primary care clinics frequently have vague symptoms that can be associated with ovarian cancer, the important difference is that these symptoms are less severe and less frequent when compared with women with ovarian cancer. Typically, symptoms occur 2 to 3 times per month and are often associated with menses, which may explain why these vague symptoms become less common and less severe as women age. In addition, women with ovarian cancer typically have symptoms of recent onset and have multiple symptoms that coexist. This study adds further evidence that ovarian cancer is not a silent disease," the authors concluded.

In an accompanying editorial, Mary B. Daly, M.D., Ph.D., and Robert F. Ozols, M.D., Ph.D., wrote, "Ovarian cancer is the leading cause of death from a gynecologic malignancy among women in the United States and the fifth leading cause of cancer deaths among women overall after lung, breast, colorectal, and pancreatic. Every year, approximately 23,000 women are diagnosed as having ovarian cancer and 14,000 women die of the disease. One reason for the relatively high case-fatality rate is failure to identify early stage disease."

"Attempts to identify sensitive and specific screening strategies for this disease to improve early detection have remained elusive," the editorial authors wrote. "In view of the failure to identify an acceptable screening approach for the early detection of ovarian cancer, symptom recognition assumes great importance."

"The findings [from the Goff and colleagues study] are consistent with previous research, and lend strong support to the notion that ovarian cancer is often preceded by a set of recognizable symptoms. It also identifies four characteristics of the symptoms that should raise clinical suspicion of ovarian cancer, namely frequency, severity, time of onset, and total number of symptoms."

"The importance of this study is not the validation of a symptom cluster as a precise way to diagnose ovarian cancer, but rather the reinforcement of the need for an ongoing process of communication between patients and their physicians. In the absence of more definitive diagnostic tools, early detection of ovarian cancer will continue to challenge both the artistic skill of astute clinicians as well as their accumulated scientific acumen."