"There is a burning need for an effective screening test" for ovarian cancer, explained Dr. Beth Karlan, director of gynecologic oncology at Cedar Sinai Medical Center, Los Angeles, California. According to Karlan, findings presented this week at a San Diego meeting of the Society of Gynecologic Oncologists suggest that ultrasound may be that test.

"Approximately 15,000 women die each year from ovarian cancer in the United States,"
Karlan explained in an interview with Reuters Health. "Because of the lack of effective screening tests, and the stage distribution -- meaning that the majority of patients present with later-stage disease -- there's a lot of fear about ovarian cancer."

TVU tested on 14,000 women without symptoms
In their study, Dr. John R. van Nagell and colleagues at the University ofKentucky in Lexington examined the diagnostic accuracy of transvaginal ultrasound in over 14,000 women with no obvious symptoms of ovarian cancer.

In transvaginal ultrasound (TVU), gynecologists insert an ultrasound probe -- slightly larger than a tampon -- into the vagina. Karlan explain that transvaginal ultrasound provides a clearer picture of the ovaries than conventional abdominal ultrasound. "Anatomically, it is closer to the ovariesin many women," she said, "and so one can image on an ultrasound screen what the ovaries look like."

The Kentucky researchers detected 17 ovarian cancers -- 11 of them stage I (early-stage cancer), 3 stage II, and 3 stage III (late-stage) -- in the14,000 women. Although the number of cancers detected was relatively small, a relatively large proportion were detected early in their development, when the likelihood of a response to therapy is at its highest.

It is often found too late in a late stage
Karlan pointed out that, as it stands now, "when one looks at the statistics for ovarian cancer, there is a preponderance of the late-stage cases."

Women who had abnormal findings on their initial ultrasound screening were referred for subsequent tests over periods of 4 to 6 weeks, to rule out the possibility that the abnormality was a transient cyst. If the abnormality was determined to be 'persistent,' patients were then referred to a series of blood and ultrasound tests to assess the need for surgery.

Karlan, who is also director of the Gilda Radner Ovarian Cancer Detection Program, notes that women involved in various studies have reported transvaginal ultrasound to be more comfortable than standard abdominal ultrasound (which requires a distended bladder for proper imaging). And she says the technology is already in place in most gynecologic clinics.

The comedienne Gilda Radner died of ovarian cancer in 1989.

Karlan stressed that the results of the Kentucky study need to be confirmed in larger, ongoing studies. However, she believes the findings show "a commitment of the community of gynecologic oncologists to really try to eradicate (ovarian cancer). I think it's the combined effort of various committed physicians and investigators that will get us an answer within this decade."

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