This article – on the potential downsides of a public awareness campaign about ovarian cancer – reminds me of health media watchdog Gary Schwitzer’s comment that “all screening tests cause harm; some may do good.” Perhaps the same might be said of disease awareness campaigns.
Increasing public awareness about ovarian cancer can have a downside
Professor Marian Pitts writes:
On an almost daily basis we are bombarded with health messages, many of them encouraging us to monitor ourselves for worrying signs that might be signals of an underlying problem.
Ovarian cancer is the latest in a long line of such concerns. It is the sixth most common cause of cancer death in Australia; and it has a poor five-year survival rate of only 42%. Many cases of ovarian cancer are undiagnosed until an advanced stage of the disease.
Against this backdrop, a National Breast and Ovarian Cancer Centre survey has shown that one in five women can’t name one symptom of ovarian cancer.
This has formed the basis of a public health campaign to raise awareness of the cancer and its associated symptoms.
The trouble is that the symptoms that may signal an underlying cancer are vague, non-specific and, as our study has found, extremely common in the general population.
Using a computer assisted telephone interview (CATI) of 2,235 women aged between 18 and 70 years of age we asked questions about the presence, severity and duration of symptoms associated with ovarian cancer.
Two-thirds of the healthy women in our study reported they had experienced one or more of the symptoms in the past year.
Over half of the women had experienced the symptom of abdominal bloating in the past twelve months (52%). Increasing abdominal size was reported by 30% and pelvic pain by 29%. Feeling full quickly, and inability to eat normally, were reported by 18% and 15% respectively. Only one third of our sample had not experienced any of these symptoms in the past year.
One in six women (17%) reported a combination of the three most common symptoms (abdominal pain, bloating and increased size).
This study, and earlier research, suggests that the presence of three or more symptoms, that are severe in experience, and persist over time are the clearer indicators of the possibility of ovarian cancer.
So, given that these ovarian cancer symptoms are so common in the community, how can we deliver a message that does not just increase women’s anxiety, lead to unnecessary consultations and, in some cases, lead to unnecessary interventions and investigations?
We may be doing more harm than good to the general population, in our understandable desire to detect this so-called silent killer early enough to improve survival rates.
I am reminded of John Howard’s message about terrorism in our midst (an even less likely occurrence than what we are discussing here). Then, we were exhorted to be alert not alarmed.
The trouble now, as then, is to identify what we might detect through our alertness.
In the case of ovarian cancer, it is not an easy or simple message to convey.
Clearly our public heath messages need to be more tailored to emphasise that, while these signs and symptoms are common in the general population, the combination of signs, their duration and particularly their severity are the important triggers to seek advice from a GP.
• Marian Pitts is Director of the Australian Research Centre in Sex, Health and Society at LaTrobe University
• This article has been cross-published with The Conversation.
Whilst it is commendable to be concerned about “doing more harm than good to the general population”, I feel you are not taking one important factor into account: the simplicity and sensitivity of a pelvic ultrasound scan to detect suspicious ovarian lesions.
Whilst the range of symptoms is indeed vague, and some of them likely to encompass at least 50% of the population, a simple transvaginal ultrasound is all that is needed to elucidate an ovarian mass lesion.
This test takes approximately 20 minutes to perform and does not use ionising radiation to acquire its images. Although it is relatively low-specificity ( mass lesions are easily found, but not able to be categorised as malignant by appearance), it is the best available test to allow the patient and their physician to plan a further course of action, such as laparoscopy or biopsy.
I feel it is rather simplistic to raise concerns about an information campaign, as if that campaign is the only approach to diagnosis in the field of ovarian pathology. As a practising medical sonographer, I feel you could have approached this important subject with better reference to the excellent diagnostic tools we have at our disposal.