Development of an ovarian cancer symptom index: possibilities for earlier detection.
BACKGROUND
Currently, screening for ovarian cancer is not recommended for the general population. Targeting women with specific symptoms for screening has been evaluated only recently, because it was believed that symptoms had limited specificity.


METHODS
A case-control study of 149 women with ovarian cancer, including 255 women who were in a screening program and 233 women who were referred for pelvic/abdominal ultrasound, was conducted by inviting women to complete a survey of symptoms. Patients were divided randomly into an exploratory group and a confirmatory group. Symptom types, frequency, severity, and duration were compared between cases and controls. Logistic regression analyses were used to determine which factors independently predicted cancer in the exploratory group and then were used to develop a symptom index, which was tested for sensitivity and specificity in the confirmatory group.


RESULTS
Symptoms that were associated significantly with ovarian cancer were pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full when they were present for <1 year and occurred >12 days per month. In a logistic regression analysis, symptoms that were associated independently with cancer were pelvic/abdominal pain (P < .001), increased abdominal size/bloating (P<.001), and difficulty eating/feeling full (P = .010). A symptom index was considered positive if any of those 6 symptoms occurred >12 times per month but were present for <1 year. In the confirmatory sample, the index had a sensitivity of 56.7 for early-stage disease and 79.5% for advanced-stage disease. Specificity was 90% for women age >50 years and 86.7% for women age <50 years.


CONCLUSIONS
Specific symptoms in conjunction with their frequency and duration were useful in identifying women with ovarian cancer. A symptom index may be useful for identifying women who are at risk.
Goff
Barbara A
BA
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington 98196-6460, USA. bgoff@u.washington.edu
Mandel
Lynn S
LS
Drescher
Charles W
CW
Urban
Nicole
N
Gough
Shirley
S
Schurman
Kristi M
KM
Patras
Joshua
J
Mahony
Barry S
BS
Andersen
M Robyn
MR
D015746:Abdominal Pain / Q000209:etiology; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires