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Ovarian cancer: can we make the clinical diagnosis earlier?
Cancer 2005; 104(7):1398-407C

Abstract

BACKGROUND

Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer.

METHODS

Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer.

RESULTS

From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%).

CONCLUSIONS

Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of California at Davis, School of Medicine, Sacramento, California 95817, USA. lhsmith@ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16116591

Citation

Smith, Lloyd H., et al. "Ovarian Cancer: Can We Make the Clinical Diagnosis Earlier?" Cancer, vol. 104, no. 7, 2005, pp. 1398-407.
Smith LH, Morris CR, Yasmeen S, et al. Ovarian cancer: can we make the clinical diagnosis earlier? Cancer. 2005;104(7):1398-407.
Smith, L. H., Morris, C. R., Yasmeen, S., Parikh-Patel, A., Cress, R. D., & Romano, P. S. (2005). Ovarian cancer: can we make the clinical diagnosis earlier? Cancer, 104(7), pp. 1398-407.
Smith LH, et al. Ovarian Cancer: Can We Make the Clinical Diagnosis Earlier. Cancer. 2005 Oct 1;104(7):1398-407. PubMed PMID: 16116591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ovarian cancer: can we make the clinical diagnosis earlier? AU - Smith,Lloyd H, AU - Morris,Cyllene R, AU - Yasmeen,Shagufta, AU - Parikh-Patel,Arti, AU - Cress,Rosemary D, AU - Romano,Patrick S, PY - 2005/8/24/pubmed PY - 2005/12/13/medline PY - 2005/8/24/entrez SP - 1398 EP - 407 JF - Cancer JO - Cancer VL - 104 IS - 7 N2 - BACKGROUND: Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS: Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS: From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS: Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/16116591/Ovarian_cancer:_can_we_make_the_clinical_diagnosis_earlier L2 - https://doi.org/10.1002/cncr.21310 DB - PRIME DP - Unbound Medicine ER -