J Gynecol Oncol.  2009 Dec;20(4):238-242. 10.3802/jgo.2009.20.4.238.

A hospital-based case-control study of identifying ovarian cancer using symptom index

• Kim MK
• Kim K
• Kim SM
• Kim JW
• Park NH
• Song YS
• Kang SB

• KMID: 2288589
• DOI: http://doi.org/10.3802/jgo.2009.20.4.238

Abstract

OBJECTIVE
Recently, a symptom index for identification of ovarian cancer, based on specific symptoms along with their frequency and duration, was proposed. The current study aimed at validation of this index in Korean population.
METHODS
A case-control study of 116 women with epithelial ovarian cancer and 209 control women was conducted using questionnaires on eight symptoms. These included pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, difficulty eating/feeling full. The symptom index was considered positive if any of the 8 symptoms present for <1 year that occurred >12 times per month. The symptoms were compared between ovarian cancer group and control group using chi-square test. Logistic regression analysis was used to determine whether the index predicted cancer. Sensitivity and specificity of the symptom index were also determined.
RESULTS
The symptom index was positive in 65.5% of women with ovarian cancer, in 31.1% of women with benign cysts, and in 6.7% of women on routine screening (ps<0.001). Significantly higher proportion of ovarian cancer patients were positive for each symptom as compared with control group (ps<0.001). Results from the logistic regression indicated that the symptom index independently predicted cancer (p<0.001; OR, 10.51; 95% CI, 6.14 to 17.98). Overall, the sensitivity and specificity of the symptom index were 65.5% and 84.7%, respectively. Analyses of sensitivity by stage showed that the index was positive in 44.8% of patients with stage I/II disease and in 72.9% of patients with stage III/IV disease.
CONCLUSION
The current study supported previous studies suggesting that specific symptoms were useful in identifying women with ovarian cancer.

Keyword

Ovarian cancer; Symptoms; Early diagnosis; Case-control study

MeSH Terms

Case-Control Studies
Early Diagnosis
Female
Humans
Logistic Models
Mass Screening
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms
Sensitivity and Specificity
Surveys and Questionnaires
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms

Reference

1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005. 55:74–108.

2. Olson SH, Mignone L, Nakraseive C, Caputo TA, Barakat RR, Harlap S. Symptoms of ovarian cancer. Obstet Gynecol. 2001. 98:212–217.

3. Vine MF, Calingaert B, Berchuck A, Schildkraut JM. Characterization of prediagnostic symptoms among primary epithelial ovarian cancer cases and controls. Gynecol Oncol. 2003. 90:75–82.

4. Smith EM, Anderson B. The effects of symptoms and delay in seeking diagnosis on stage of disease at diagnosis among women with cancers of the ovary. Cancer. 1985. 56:2727–2732.

5. Yawn BP, Barrette BA, Wollan PC. Ovarian cancer: the neglected diagnosis. Mayo Clin Proc. 2004. 79:1277–1282.

6. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004. 291:2705–2712.

7. Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007. 109:221–227.

8. Goff BA, Mandel L, Muntz HG, Melancon CH. Ovarian carcinoma diagnosis. Cancer. 2000. 89:2068–2075.

9. Jacobs I, Davies AP, Bridges J, Stabile I, Fay T, Lower A, et al. Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ. 1993. 306:1030–1034.

10. Olivier RI, Lubsen-Brandsma MA, Verhoef S, van Beurden M. CA125 and transvaginal ultrasound monitoring in high-risk women cannot prevent the diagnosis of advanced ovarian cancer. Gynecol Oncol. 2006. 100:20–26.

11. Jacobs IJ, Skates SJ, MacDonald N, Menon U, Rosenthal AN, Davies AP, et al. Screening for ovarian cancer: a pilot randomised controlled trial. Lancet. 1999. 353:1207–1210.

12. Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009. 10:327–340.

13. Webb PM, Purdie DM, Grover S, Jordan S, Dick ML, Green AC. Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer. Gynecol Oncol. 2004. 92:232–239.

14. Friedman GD, Skilling JS, Udaltsova NV, Smith LH. Early symptoms of ovarian cancer: a case-control study without recall bias. Fam Pract. 2005. 22:548–553.

15. An experiment in earlier detection of ovarian cancer. Lancet. 2007. 369:2051.

16. Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ. 2009. 339:b2998.

17. Lataifeh I, Marsden DE, Robertson G, Gebski V, Hacker NF. Presenting symptoms of epithelial ovarian cancer. Aust N Z J Obstet Gynaecol. 2005. 45:211–214.

18. Eltabbakh GH, Yadav PR, Morgan A. Clinical picture of women with early stage ovarian cancer. Gynecol Oncol. 1999. 75:476–479.

19. Andersen MR, Goff BA, Lowe KA, Scholler N, Bergan L, Dresher CW, et al. Combining a symptoms index with CA 125 to improve detection of ovarian cancer. Cancer. 2008. 113:484–489.