The scientific basis of early detection of epithelial ovarian cancer: the National Ovarian Cancer Early Detection Program (NOCEDP).

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In the United States ovarian cancer is the leading cause of death from gynecologic malignancies and is the fifth most common female malignancy. Each year approximately 24,000 women will be newly diagnosed with ovarian cancer and 14,000 will die from this disease. In industrialized countries ovarian cancer accounts for more deaths than uterine and cervical cancer combined. The incidence of ovarian cancer has been steadily increasing over the past ten years, now with an overall lifetime risk of 1.8%. Ovarian cancer rapidly increases in occurrence after age 40 with the mean age of occurrence at 60 (1). Epidemiologic factors associated with ovarian cancer include nulliparity, a personal history of colon or breast cancer, an affected first degree relative with ovarian cancer, a family history of a recognized inherited malignancy syndrome, as well as a history of prolonged use of fertility drugs (2). Due to our current inability in detecting cancer confined to the ovary (stage I disease), the majority of women (75%) are diagnosed with tumor spread throughout the abdominal cavity (stage III or IV). This extensive spread of ovarian carcinoma often is associated with subtle symptoms such as bloating, early satiety, abdominal discomfort, or changes in bowel or bladder habits; vague symptoms that may often be dismissed by patient and/or healthcare provider or simply misdiagnosed. It is the anatomic location of the ovaries that contributes to our inability to detect early stage ovarian carcinoma. Despite significant improvements in surgical techniques, critical care and new chemotherapeutic regimens, the overall 5-year survival for women with stage III/IV epithelial ovarian carcinoma has remained constant (12 – 20%) over the past 30 years. Conversely, those patients diagnosed with stage I disease usually only require surgical intervention without chemotherapy and have an overall 5-year survival approximating 90%. Therefore the early detection of early stage epithelial ovarian cancer is essential in curbing the morbidity and mortality from this disease.