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Guidelines fail to identify most early stage ovarian cancers

Last Updated: 2007-10-12 17:46:52 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Guidelines published by the American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncologists for referring a patient with a pelvic mass to a gynecologist oncologist perform poorly in identifying early-stage disease, particularly among premenopausal women, according to a report in the October issue of Obstetrics and Gynecology.

On the other hand, these guidelines perform well in identifying patients with advanced stage disease, Dr. William Cliby of the Mayo Clinic in Rochester, Minnesota and associates report.

The 5-year survival among women with late-stage ovarian cancers is 30%, the investigators note, whereas 5-year survival for early-stage disease is 93%, underscoring the need for better ways to identify stage I and II disease.

To evaluate the sensitivity of the guidelines, the investigators analyzed data from patients at their institution who were seen for pelvic mass between 2001 and 2006. Included were 837 patients, 597 of whom were postmenopausal and 240 were premenopausal.

Nearly half (44%) of the postmenopausal women were diagnosed with ovarian cancer, as were 20% of the premenopausal women. Overall, 74% of the primary cancers were stage III or IV.

Sensitivity and specificity for detecting cancer among postmenopausal women were 93.2% and 59.9%; for premenopausal women, the corresponding values were 79.2% and 69.8%. Positive predictive values were 64.6% and 39.6%, respectively.

Dr. Cliby's team evaluated the criteria used to determine referral to a specialist which included: menopausal status, CA 125 level, imaging results, physical findings, and family history of breast or ovarian cancer.

They recommend that the referral guidelines be revised to exclude family history of breast or ovarian cancer. Women with a positive family history should be evaluated using different guidelines, the researchers note.

They also recommend lowering the CA125 cutoff to 67 units/mL, which would increase the sensitivity of the guidelines for premenopausal women.

Obstet Gynecol 2007;11:841-848.

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