Symptom-Triggered Testing Helps Identify Ovarian Cancers Early

The use of symptom-triggered testing for ovarian cancer resulted in 1 in 4 women being diagnosed with high-grade serous ovarian cancer at an early stage, a new study conducted in the United Kingdom showed.

According to the study, “symptom-triggered testing for ovarian cancer was endorsed by cancer organizations in the USA, namely the American Cancer Society, Foundation for Women’s Cancer, and the Society of Gynecologic Oncology in 2007, and the UK followed suit in 2011.”

Symptom-triggered testing calls for women with possible symptoms of ovarian cancer – which may include symptoms like pain, increased abdominal size and/or bloating, and early satiety – to undergo ultrasound scan and serum CA125, and be referred to hospital within 2 weeks if these are abnormal.

“Symptom-triggered testing may help to identify women with low disease burden, potentially contributing to high complete cytoreduction rates and improving survival outcomes in these patients,” wrote researchers led by Fong Lien Audrey Kwong, of the Panbirmingham Gynaecological Cancer Centre. “As this is one of the largest prospective series in the UK, we consider that our data are generalizable and have implications for the UK but also other healthcare systems.”

The study looked at data from 1,741 women recruited via the fast-track pathway from the Refining Ovarian Cancer Test Accuracy Scores (ROCkeTS) single-arm prospective study. Histology details were available for all women who underwent surgery or biopsy; women who did not undergo surgery or biopsy at 3 months were followed up for 12 months.

Of the included women, 12.3% were diagnosed with primary ovarian cancer; 6.8% were diagnosed with high-grade serous ovarian cancer. The majority (94.1%) of women diagnosed with high-grade serous ovarian cancer had a performance status of 0 or 1 at diagnosis.

The extent of disease was low (36.1%) or moderate (28.6%) in the majority of women. About one in four (25.2%) of the high grade serous ovarian cancer diagnoses were stages I/II. According to the researchers, this findings challenges “the assumption that the disease should always be considered to be in its advanced stages in women once they develop symptoms” and emphasizes “the importance of increasing an awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway to improve patient outcomes.”

Of the women with high grade serous ovarian cancer, 65.5% underwent primary debulking surgery, 30.3% received neoadjuvant chemotherapy plus surgery, and 4.2% did not receive surgery.

Complete cytoreduction was achieved in 61.3% of patients and optimal cytoreduction in 15.1%. Based on this, the researchers wrote “that symptom-based testing may play an essential role in facilitating the early detection of low-volume disease, and therefore high complete cytoreduction rates.”

Reference

Symptom-triggered testing detects early stage and low volume resectable advanced stage ovarian cancer