Ovarian cancer affects about 7,000 women in the UK each year. When it is detected early – that is when the disease is still confined to the ovary – it is curable. Unfortunately 70 per cent of women with ovarian cancer are diagnosed with advanced-stage disease, where the survival rate is only 20 to 30 per cent.
The big problem with ovarian cancer is that the early symptoms are often vague and non-specific, for example:
• Persistent distension/swelling/bloating of the tummy (abdomen)
• Unexplained pelvic or abdominal (tummy) pain
• Needing to pass urine more often than usual (frequency) or more suddenly than normal (urgency) in a way that does not have a clear cause such as a urine infection
• Unexplained loss of appetite, weight loss and/or feeling full quickly
• Persistent changes to bowel habits such as unexplained constipation or more frequent/loose motions
CA125 is a chemical given off by cancer cells that circulates in the bloodstream. Women with ovarian cancer tend to have higher levels of CA125 in their blood than women who do not have ovarian cancer.
In 2011 the National Institute for Health and Care Excellence (NICE) recommended that women with symptoms that might be caused by ovarian cancer should be offered a CA125 blood test. But the problem for me as a practising GP is that the symptoms listed earlier are very common. Picking up ovarian cancer depends on all GPs having ovarian cancer in the forefront in their minds every time a patient comes in with one of these non-specific symptoms. Unfortunately, some recent data assembled by a colleague at the University of Leeds has revealed that this does not occur, with a 10-fold difference in CA125 testing across the country — so you are much more likely to be tested in Portsmouth than Luton.
In this context ovarian cancer screening should be given much more serious consideration. Moreover, last year a UK study looking at ovarian cancer screening in the general population was completed. The initial results from this research suggest that annual CA125 screening (using a computerised algorithm to interpret the results) can pick up 85 per cent of ovarian cancers, with just under half of these being diagnosed at an early (and curable) stage.
So what can be done to help women to beat ovarian cancer? I have three recommendations:
1. Know your risks.
Having close relatives – mother, brothers or sisters – diagnosed with ovarian or breast cancer increases a person’s chances of developing ovarian cancer themselves. And if your relations have been diagnosed before the age of 50 years this increases your risk considerably.
The free OPERA interactive tool is a particularly useful way to assess your inherited risk for ovarian cancer.
2. Get screened.
Based on the evidence published so far I would now recommend that all women, especially those over the age of 40 years, should have annual CA125 testing.
But it is also important to be aware that 15 per cent of women with ovarian cancer will not have a raised CA125 result and a ‘normal’ CA125 reading should also be treated with caution in the presence of any symptoms or in people with a strong family history of breast/ovarian cancer. In these circumstances it is worth exploring the possibility of having a transvaginal ultrasound examination in order to directly visualise the ovaries.
3. Don’t trust the clinical examination
Traditionally an internal vaginal examination has been promoted as a way to screen for diseases in adult women who do not have any symptoms. A number of private health screening companies also continue to advocate the internal examination as a way to spot ovarian cancer.
But an article published last year by a group from the American College of Physicians casts significant doubt on the benefits of the vaginal examination. Based on a review of 52 separate studies they concluded that that the examination rarely detected important disease and does not reduce death rates. Moreover, in over a third of women it causes pain, discomfort, fear, anxiety and embarrassment.
As a GP with an interest in cancer diagnosis I particularly worry about ovarian cancer. It has been estimated that if survival from ovarian cancer in Britain equalled the best in Europe, then 2,400 deaths could be avoided within five years of diagnosis. I hope that the three recommendations I have made here might contribute to narrowing this unacceptable gap.