All symptoms had positive predictive values below 1%, except for abdominal distension, which had a positive predictive value of 2.5%. This means that it carries the highest risk and warrants rapid investigation, say the authors. Yet persistent abdominal distension is not included in current guidance for urgent investigation. If it were, some women could have their diagnosis speeded up by many months.
The fact that symptoms are common and often reported is encouraging as it means there is some chance of identifying early ovarian cancer by using symptoms, say the authors. This study provides an evidence base for selection of patients for investigation, both for clinicians and for developers of guidelines, they conclude.
There is now increasing evidence that ovarian cancer is not a “silent killer” but one that presents with vague symptoms that have a low positive predictive value for cancer, writes Dr Robin Fox in an accompanying commentary.
This study adds to the evidence base derived from primary care of red flag symptoms for several cancers, and is important as most patients in the United Kingdom present initially to primary rather than secondary care, he writes.
The diagnosis of ovarian cancer will continue to be a challenge for primary care doctors, adds Joan Austoker from the University of Oxford, in an accompanying editorial.
She believes that more research is needed to improve our knowledge of the predictive value of different symptoms in ovarian cancer. In the meantime, what is important for both women and primary care doctors is that ovarian cancer can no longer be regarded as a silent killer, she says.
Source-BMJ
SRM