Journal Club - January 2005

Frequency of symptoms of ovarian cancer in women presenting to primary care clinics.
Goff BA, Mandel LS, Melancon CH, Muntz HG.
JAMA. 2004 Jun; 291: 2705-2712. [Abstract]

Summary
Goff and coworkers performed a prospective case-control study of 128 women undergoing surgery for a pelvic mass and 1,709 women who visited 2 primary care clinics and completed an anonymous survey on the severity of their symptoms between July 2001 and January 2002. The objective of the study was to compare the frequency, severity, and duration of symptoms between women with ovarian cancer and women presenting to primary care clinics. The primary outcome measure was differences in self-reported symptoms between these groups of women. Compared to control patients (those women attending primary care clinics), ovarian cancer patients were 7.4 times more likely to report increased abdominal size, 3.6 times more likely to complain of bloating, 2.5 times more likely to have urinary urgency, and 2.2 times more likely to have pelvic pain. All of these differences were statistically significant. In addition, these investigators found that the combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of women with ovarian cancer but only 8% of women presenting to primary care clinics.

Discussion
This is an important study in several respects. The investigators have expanded on their previous work demonstrating that 95% of women with ovarian cancer experience some symptoms prior to diagnosis (Goff et al Cancer 2000; 898: 2068-2075), dispelling the myth that ovarian cancer is a silent disease. The results of the current study indicate that women with ovarian pathology are more likely to experience a specific constellation of symptoms that are more severe and frequent than their counterparts presenting to primary care clinics.

Conclusion
These data suggest that women presenting with non-specific symptoms, particularly if severe intensity or rapid onset, should be thoroughly evaluated for the possibility that the symptoms are due to an ovarian mass.

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