|Home | About | Journals | Submit | Contact Us | Français|
To the editor: It used to be regarded that ovarian cancer was a "silent killer." However, recent studies have revealed that the majority of patients with ovarian carcinoma have symptoms for at least several months prior to their diagnosis.1-4 Dr. Kim and colleagues published an article in the December issue of Journal of Gynecologic Oncology entitled "A hospital-based case-control study of identifying ovarian cancer using symptom index."5 Although some data set is impressive, the title of the manuscript cannot either be supported or refuted by the analysis and may therefore be a little bit misleading.
The study included 116 women with epithelial ovarian cancer and 209 control women using questionnaires on eight symptoms. These included pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, difficulty eating/feeling full. The symptom index was considered positive if any of the 8 symptoms present for <1 year that occurred >12 times per month. The symptom index was positive in 65.5% of women with ovarian cancer, in 31.1% of women with benign cysts, and in 6.7% of women on routine screening (ps<0.001). Significantly higher proportion of ovarian cancer patients were positive for each symptom as compared with control group (ps<0.001). Also, they concluded that previous studies suggesting that specific symptoms were useful in identifying women with ovarian cancer.
However, the population of study is heterogeneous and small to represent the whole Korean population. The diagnosis is ovarian cancer in 116, benign ovarian cyst in 74, control group in 135 women. We also do not know the histological subtype of those ovarian cancers (i.e., epithelial, borderline, or stromal). The natural course of disease and response rate to symptoms index will be different from one histological subtype to another. Likewise, some studies have classified the study population into three groups for comparison based on their diagnosis: borderline, early and advanced cancer.
Finally, in future publications on this topic, it would be helpful to specify very carefully the population characteristics to classify patients with ovarian carcinoma.