Screening for Ovarian Cancer Based on Symptoms – Not Good Enough

Thanks to Toni Brayer for pointing out this new study on ovarian cancer symptoms published in the Journal of the National Cancer Institute.

This study confirms previous studies which found that ovarian cancer, long thought to be a silent disease in its early stages, does indeed have symptoms. The problem is that those symptoms – bloating, urinary frequency, pelvic pain, early satiety – are common, non-specific and, according to this new study, 99% of the time not due to an underlying ovarian cancer.

That’s good news, of course, for women with these symptoms. But bad news for those hoping for a means of early detection for ovarian cancer, since early symptom recognition is neither sensitive nor specific enough to be useful as a screening test on a population basis.

This is extremely important for women to understand. Each new screening test gets over-hyped and sets women up with unrealistic expectations about just what it is we docs can do to diagnose this disease. (The latest hope comes from a study that found elevated serum markers in women with ovarian cancer up to three years before their cancer was diagnosed. Unfortunately, the test were not useful in discriminating normals from abnormals until shortly before diagnosis.)
I don’t know if the results of this new symptom screening study will lead to changes in the current recommendations for ovarian cancer screening, so for now I will just reiterate them here –
If you have any of the following symptoms almost daily for more than a few week and these symptoms represent a change from normal for you, see your doctor, preferably a gynecologist.

  • Bloating
  • Pelvic or abdominal pain
  • Urinary urgency or frequency
  • Difficulty eating or feeling full quickly

Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Remember, though, that these symptoms are almost always caused by something other than ovarian cancer.


Wouldn’t it be great if we had a pill to prevent ovarian cancer?
Wait a minute – we already do! It’s call the Birth Control Pill. According to the National Cancer Institute, use of the pill for even as little as a year lowers ovarian cancer risk by 10-12%, and there is a 50% risk reduction after 5 years of use. Other studies show even higher risk reduction with longer term use.
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Those ovarian cancer awareness wristbands up there are sold to raise funds for the Lynne Cohen Ovarian Cancer Research Foundation. The Susan Komen Foundation sells them too. The Ovarian Cancer Research Fund has a whole store!

More info on ovarian cancer screening from The National Cancer Institute.

21 Responses to Screening for Ovarian Cancer Based on Symptoms – Not Good Enough

  1. Hi,

    This is completely unrelated to your blog post, but I had a question I'm in my 20s and have a gyn appointment coming up. Do doctors have any opinion on the grooming of hair (or lack of) down there? How should I present? Excuse me for TMI info, but I don't don't want to be completely bald for the appointment since it would show I was trying too hard just for the doctor, so perhaps I should leave a 5 o'clock shadow? I'm thinking too much, but it's a fear of mines.

    Perhaps you can do a blog post on this topic. Thanks. Love your blog posts and food recipes 🙂

  2. Great post and thanks for the mention, TBTAM. Reminding women that the birth control pill can prevent ovarian cancer is an important concept too.

    On another note, I'm anxiously awaiting your response to "Thinks Too Much…"

  3. I would rather you said that the birth control pill reduces the risk of getting ovarian cancer rather than prevents it. It cuts your risk significantly, but it does not reduce it to zero. (My anecdotal evidence is a friend who was on the pill when she got her dx 12 years ago. Fortunately, she's doing well now!)

  4. RA thanks for your comment, I have lost two people I was close to from ovarian cancer and one was not on the pill ever the other one might have been at some point. From my experience nothing can prevent ovarian cancer. The relative didn't have any history of it, my friend had a mother with breast cancer which I know ups the risk, like a relative with ovarian ups the risk of breast cancer.

  5. RA and Anon – You are correct – the pill can reduce the risk of ovarian cancer by as much as 50-60%. That's a pretty significant risk reduction, and with nothing else out there to reduce risk, an important thing for women to know. But unfortunately, it is not 100% reduction, as you can attest. So sorry to hear what your friends and family have been through.

    Most ovarian cancer occurs in women without a family history. We don't know what causes it, and we don't have a good screening test to detect it early.

    Maybe someday we will.

    Peace.

  6. Just got anther comment (Off line) from a reader objecting to my use of the word "prevent" when it comes to birth control pills and ovarian cancer, accompanied again by the story of a friend who got ovarian cancer and had used the pill in the past.

    Pills are NOT 100% effective at preventing ovarian cancer, just as seat belts don't prevent 100% of traffic accident deaths or fire alarms prevent 100% of deaths from household fires. But we still use the word prevent when we discuss these interventions.

    I've added data on risk reduction to the paragraph above to settle the discussion down, and corrected data in my previous comment – I meant to write 60% and wrote 80% instead.

  7. Don't these symptoms mean that something has grown in the pelvic area enough to be jostling other organs around?

    How can it be early stage if the growth has gotten that intrusive?

  8. It's so sad that we haven't made very much progress on disease detection.

    Maybe more effort should be put in finding better treatments instead?

    As even successful and recommended early detection tests for other cancers showed, screening is always a mixed bag: many tests aren't nearly as effective as most women believe, and all have a chance to harm healthy women. So, why not concentrate the research not as much on detecting cancers earlier but distinguishing cancers that would progress from those that wouldn't and finding better treatments.

    As to ovarian cancer, nobody really knows that even the most perfect early test would make a difference: isn't it quite possible that those cancers detected in curable stages are simply slow-growing and hence are detected earlier?

  9. I would rather you said that the birth control pill reduces the risk of getting ovarian cancer rather than prevents it. It cuts your risk significantly, but it does not reduce it to zero. (My anecdotal evidence is a friend who was on the pill when she got her dx 12 years ago. Fortunately, she’s doing well now!)

  10. Just got anther comment (Off line) from a reader objecting to my use of the word “prevent” when it comes to birth control pills and ovarian cancer, accompanied again by the story of a friend who got ovarian cancer and had used the pill in the past. Pills are NOT 100% effective at preventing ovarian cancer, just as seat belts don’t prevent 100% of traffic accident deaths or fire alarms prevent 100% of deaths from household fires. But we still use the word prevent when we discuss these interventions. I’ve added data on risk reduction to the paragraph above to settle the discussion down, and corrected data in my previous comment – I meant to write 60% and wrote 80% instead.

  11. I would rather you said that the birth control pill reduces the risk of getting ovarian cancer rather than prevents it. It cuts your risk significantly, but it does not reduce it to zero. (My anecdotal evidence is a friend who was on the pill when she got her dx 12 years ago. Fortunately, she’s doing well now!)

  12. RA and Anon – You are correct – the pill can reduce the risk of ovarian cancer by as much as 50-60%. That’s a pretty significant risk reduction, and with nothing else out there to reduce risk, an important thing for women to know. But unfortunately, it is not 100% reduction, as you can attest. So sorry to hear what your friends and family have been through. Most ovarian cancer occurs in women without a family history. We don’t know what causes it, and we don’t have a good screening test to detect it early. Maybe someday we will. Peace.

  13. Just got anther comment (Off line) from a reader objecting to my use of the word “prevent” when it comes to birth control pills and ovarian cancer, accompanied again by the story of a friend who got ovarian cancer and had used the pill in the past. Pills are NOT 100% effective at preventing ovarian cancer, just as seat belts don’t prevent 100% of traffic accident deaths or fire alarms prevent 100% of deaths from household fires. But we still use the word prevent when we discuss these interventions. I’ve added data on risk reduction to the paragraph above to settle the discussion down, and corrected data in my previous comment – I meant to write 60% and wrote 80% instead.

  14. I would rather you said that the birth control pill reduces the risk of getting ovarian cancer rather than prevents it. It cuts your risk significantly, but it does not reduce it to zero. (My anecdotal evidence is a friend who was on the pill when she got her dx 12 years ago. Fortunately, she’s doing well now!)

  15. I would rather you said that the birth control pill reduces the risk of getting ovarian cancer rather than prevents it. It cuts your risk significantly, but it does not reduce it to zero. (My anecdotal evidence is a friend who was on the pill when she got her dx 12 years ago. Fortunately, she’s doing well now!)

  16. It’s so sad that we haven’t made very much progress on disease detection.Maybe more effort should be put in finding better treatments instead?As even successful and recommended early detection tests for other cancers showed, screening is always a mixed bag: many tests aren’t nearly as effective as most women believe, and all have a chance to harm healthy women. So, why not concentrate the research not as much on detecting cancers earlier but distinguishing cancers that would progress from those that wouldn’t and finding better treatments.As to ovarian cancer, nobody really knows that even the most perfect early test would make a difference: isn’t it quite possible that those cancers detected in curable stages are simply slow-growing and hence are detected earlier?

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