Gynecologic Health Gynecologic Cancers

Ovarian Cancer: Not So Silent?

Doctors and cancer advocates have traditionally been at a loss when it comes to making recommendations to women for the early detection of ovarian cancer. Not only is there no effective screening tool, it is not associated with any signature symptom. As a result, ovarian cancer is often called "the silent cancer."

However, this cancer's impact is clearly heard. Every year, approximately 23,000 women in the United States are diagnosed with ovarian cancer and 14,000 die of the disease. It is the fifth leading cause of cancer death for women, but detection at an earlier stage of the disease would help more women live longer. While the five-year survival rates for early-stage ovarian cancer are between 70 and 90 percent, they drop to 20 to 30 percent for women with advanced-stage ovarian cancer.

But there was a glimmer of hope in a 2004 study, published in the Journal of the American Medical Association, that suggested ovarian cancer does give some hints that could help lead to early detection. The researchers found that 95 percent of the participants with ovarian cancer reported symptoms before their diagnoses, including back pain, fatigue, bloating, constipation, abdominal pain and a feeling that they had to urinate urgently.

Below, Dr. Mary Daly, director of cancer prevention and control at Fox Chase Cancer Center in Philadelphia, discusses this study and the importance of weighing these symptoms in context of a woman's individual circumstances.

Why are most woman diagnosed with ovarian cancer in the advanced stages?
“That's a question that I don't think we have an answer to,” says Daly. “The traditional thinking has been because it doesn't produce obvious, recognizable symptoms.” Since there are no clues the cancer is there, it is allowed to progress into the advance stages.

The other theory has been that it just grows so rapidly that there is a very short period of time when it's at an early stage. Experts still don't really know which of those two theories are true.

Why isn't routine screening for ovarian cancer recommended?
The existing tests, which are primarily ultrasound and a blood test called CA-125, have been studied in a variety of different settings. Unfortunately they aren’t accurate enough in early diagnosis of ovarian cancer to be used as a screening test for everyone. They either miss the cancer completely, or on the other hand, they are positive when there is no ovarian cancer. So their accuracy is too inadequate to make them useful as general screening tools.

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