Abstract
BackgroundAlthough detecting ovarian cancer at early stage is a highly meaningful clinical goal, no studies have evaluated early stage disease presentation in a large community‐based population and how it differs from that of late stage disease.MethodsElectronic medical records were evaluated for women diagnosed with ovarian or fallopian tube cancer in 2016 and 2017 to identify the first imaging study to detect disease. Women being followed prior to diagnosis for known genetic risk from BRCA or other mutation were excluded. The visit in which the imaging test was ordered and related encounters were reviewed to determine the indication for imaging. Patient characteristics, presenting symptoms and duration, and modality of first abnormal imaging were compared for early vs late stage ovarian cancer and by provider specialty.ResultsOf 540 women with ovarian cancer, 190 (35%) were diagnosed with early stage disease, of whom 141 (74%) were symptomatic, with 45% of women presenting to internists, 33% to gynecologists, and 20% to emergency medicine physicians. Pelvic ultrasonography detected only 23% of late stage cases whereas pelvic ultrasonography and abdominal pelvic computed tomography (CT) each detected 47% of early stage cases. While abdominal pain and bloating were common to both women with early and late stage cancer, women with early stage disease were younger (58 vs 64 years, P < .0001), more likely to present to gynecologists (33% vs 15%, P < .001) and complained more often of a palpable mass (17% vs 6%, P < .0001) or postmenopausal bleeding (11% vs 5%, P < .001).ConclusionsExcluding women with genetic predisposition to ovarian cancer known prior to diagnosis, approximately three out of four cases of early stage ovarian cancer are detected as the result of evaluation of symptoms and one in four cases are detected incidentally. Abdominal pelvic CT and pelvic ultrasonography each detect an equal proportion of early stage cases. In contrast to late stage presentation, women diagnosed with early stage disease present more often with complaints of a palpable mass or postmenopausal bleeding, particularly to gynecologists.
Highlights
Ovarian cancer affects approximately 22 000 women annually in the US and ranks 11th in numbers of women affected but 5th in cancer deaths, largely due to frequent diagnosis at late stage.[1]
To the best of our knowledge, this is the first study to evaluate ovarian cancer clinical presentation for an entire large, diverse community‐based population including how presenting symptoms and the diagnostic process vary for early compared to late stage cancers and by clinical specialty
Three of four women with ovarian cancer have disease detected by non‐gynecologists, with internists detecting 49% of ovarian cancers overall and 45% of early stage cases compared to gynecologists detecting 21% of cancers overall and 33% of early stage cases
Summary
Ovarian cancer affects approximately 22 000 women annually in the US and ranks 11th in numbers of women affected but 5th in cancer deaths, largely due to frequent diagnosis at late stage.[1]. Patient characteristics, presenting complaints, duration of symptoms, and modality of imaging to first detect disease were analyzed in comparisons by stage (early vs late), as well as by provider specialty.
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