Barbara A. Goff, MD

Ovarian cancer was called the “silent killer” because it was thought to have no  symptoms until it was too late to make a difference. But the ovarian cancer  survivor community recognized the existence of symptoms often ignored by the  medical community. Only 20 percent of the 22,000 annual cases of ovarian cancer  in the United States are diagnosed at an early stage, a point when the chance of  cure is 70 to 90 percent. However, the vast majority of cases are diagnosed in  advanced stages, when the cure rate falls to 10 to 20 percent..

My interest in early detection of ovarian cancer began in 1998. While  speaking at a conference for cancer survivors, I listened in on an ovarian  cancer lecture. A woman in the audience asked the speaker to elaborate on the  early symptoms of ovarian cancer. He explained that there really were none. The  audience became very angry, and I remember sitting in the back of the room  thinking I was glad I didn’t get assigned that topic to speak on because I would  have given the same answer. We, as medical professionals, had been taught that  ovarian cancer has no symptoms until it reaches the advanced stages.

After the lecture, I talked with several of the women and was impressed by  the clarity with which they recalled symptoms they had leading up to their  diagnoses. My research interests were in identifying mechanisms for chemotherapy  resistance in ovarian cancer, but I was urged by the advocates to conduct a  study that would be taken seriously by the medical community.

So in 2000, I teamed up with Cindy Melancon, a founding member of the Ovarian  Cancer National Alliance who later lost her life to the disease, and others to  publish the results of a national ovarian cancer survey that confirmed 97  percent of women with ovarian cancer experience symptoms prior to diagnosis. We  also found that women with early-stage disease—those with the best chance of  cure&mdash;did, in fact, have symptoms prior to diagnosis. We looked at problems with  delayed diagnosis and misdiagnosis, both on the patient side and the physician  side. We found that neither women nor physicians understood that specific  symptoms could be associated with ovarian cancer.

We did follow-up studies evaluating symptoms in women presenting to primary  care clinics and compared them to women with ovarian cancer. While symptoms of  ovarian cancer were common in the general population, we found significant  differences in the frequency and duration of symptoms in cancer patients versus  the general population.

Further studies identified persistent bloating, abdominal pain, urinary  symptoms, and feeling full too quickly as being predictive of having ovarian  cancer when they occurred more than 12 times per month and had been present for  less than a year. Although many other symptoms are common in ovarian cancer  patients, they are not as useful in identifying the disease since they are found  at equal frequencies in the general population without cancer.

Based on this research, in June 2007, the Gynecologic Cancer Foundation,  joined by the Society of Gynecologic Oncologists, the American Cancer Society,  and 38 advocacy organizations, released the “Ovarian Cancer Symptoms Consensus  Statement” to confront the lack of recognized early warning signs and symptoms  for the deadliest gynecologic cancer.

Since there is no screening test for ovarian cancer, this consensus statement  hopefully will lead to symptom recognition by both women and their physicians,  and may allow for earlier diagnosis when a cure is more likely—90 percent, in  fact, for women diagnosed with stage 1 ovarian cancer.

—Barbara A. Goff, MD, is director of the Division of Gynecologic  Oncology at the University of Washington, and a member of the Gynecologic Cancer  Foundation and Society of Gynecologic Oncologists. The “Ovarian Cancer Symptoms  Consensus Statement” can be found at 

. For more  information or to take a confidential risk assessment, visit GCF’s Women’s  Cancer Network at 

Articles

Ovarian cancer survivor advocates led the way for scientific studies of early symptoms of ovarian cancer and are ultimately responsible for the recognition and consensus statement on the warning signs by the medical community.

Barbara A. Goff, MD

When Survivors Speak And Physicians Listen

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