Pulse
The Not-So-Silent Killer
Minnesota research points to early signs of ovarian cancer.
Barbara Yawn, M.D., is challenging the wisdom that ovarian cancer is asymptomatic in its initial stages.
Yawn, director of research at Olmsted County Medical Center in Rochester, and her team retrospectively reviewed the medical records of women who sought care in Olmsted County between 1985 and 1997. In particular, they examined the records of those patients diagnosed with the disease. The results revealed some commonly documented early symptoms that women presented with before being diagnosed with ovarian cancer. Those symptoms included abdominal cramps and urinary frequency or incontinence.
Approximately 22,000 women will be diagnosed with ovarian cancer in 2005, and about 16,000 will die from the disease, according to the American Cancer Society. Currently, about 60 percent of women with ovarian cancer are diagnosed at Stages III or IV, when the five-year survival rate can be as low as 10 percent. The five-year survival rate for a Stage I diagnosis can be as high as 80 percent. “Obviously, the point is that the earlier you can diagnose it, the better your chances of surviving the disease—or even being cured of it,” Yawn says.
Yawn acknowledges that the study has its limitations—namely, that it relies on women reporting symptoms during visits and physicians recording them comprehensively. She also understands that these early symptoms of ovarian cancer are shared by a host of other conditions and diseases, including urinary tract infections, perimenopausal changes, and uterine fibromas. “The take-home message here is that when a woman comes in and complains of crampy abdominal pain or urinary symptoms, and you can’t find a reason, or if some of the suggested treatments do not make her feel better, you need to go the next step,” she says. Yawn adds that all women who present with these symptoms should have a pelvic exam to screen for ovarian masses.
As a follow up to the retrospective study, Yawn is reviewing clinical protocols for abdominal pain and trying to remind or educate physicians about the importance of pelvic exams for women who complain of such symptoms. To make her point and encourage physicians to look beyond the obvious, she puts a new twist on an old medical school adage: “If you hear hoof beats and you look and see that they aren’t horses, then think of zebras—because occasionally, that’s what you are going to find.”—J.Mettner