Still, a Cruel Diagnosis
Tuesday, February 14, 2006
Before she died last month, Coretta Scott King turned to a Mexican alternative medicine clinic for treatment -- never begun -- of her stage III ovarian cancer. Whatever her reasons, with that move, the widow of slain civil rights icon Martin Luther King Jr. spotlighted a grim truth, say cancer experts: With even the best mainstream medical care, the odds for fighting advanced cases of the disease are poor.
"Despite the fact that many women [with the disease] are living longer, despite the fact that there are more drugs now that can buy us time, and despite the fact that we are getting closer to a reliable screening test, ovarian cancer is still a deadly and dangerous disease," said Susan Lowell Butler, executive director of the D.C. Cancer Consortium and co-founder of the Ovarian Cancer National Alliance, an advocacy group.
King reportedly was diagnosed with ovarian cancer in November and was told by U.S. doctors that her condition was terminal, according to news reports. Last month she sought treatment at the Santa Monica Health Institute, not far from San Diego, which boasted a "very eclectic approach" to "diseases by and large considered incurable by the orthodox medical profession," according to its Web site. The clinic was shut down by Mexican authorities shortly after King's death for performing unauthorized treatments and unproven surgeries.
Mainstream medical treatment, had King received it, likely would have included some combination of surgery (to remove the uterus and the ovaries), radiation and chemotherapy. A more targeted method of delivering chemotherapy -- called intraperitoneal therapy (IP) -- might also have been an option. In this procedure, chemo drugs are administered via a catheter not into a vein in the arm, as is standard, but directly into the abdomen, where the cancer is located.
The National Cancer Institute (NCI) issued a statement last month encouraging the use of both intravenous and IP chemotherapy for women with advanced ovarian cancer. The combined treatment extends "overall survival" for women with advanced ovarian cancer "by about a year," said an NCI statement. The announcement followed the publication in the New England Journal of Medicine of a large Johns Hopkins study showing that IP therapy improved survival among women with stage III ovarian cancer, the type King had.
But the news didn't alter the fact that treating cancer at this stage is difficult, and diagnosing it earlier remains a challenge. "Ovarian cancer is the leading cause of gynecologic cancer deaths in the United States," said Robert Bristow, director of the Kelly Gynecologic Oncology Service and the Ovarian Cancer Center of Excellence at Johns Hopkins Medical Institutions. "That fact has held true over the last 20 or 30 years."
Ovarian cancer is the seventh most common cancer in women, reports the American Cancer Society (ACS), and the fourth leading cause of cancer death in women. Five-year survival rates for ovarian cancer are 44 percent overall, compared to about 88 percent for breast cancer survivors and 99 percent for prostate cancer survivors, according to the ACS. Most ovarian cancer cases occur after menopause; half are found in women older than 63, according to a booklet developed by the ACS and the National Comprehensive Cancer Network. King was 78.
One reason ovarian cancer statistics are so discouraging is that a reliable screening method for the disease doesn't exist. A blood test called CA-125, which identifies some ovarian cancer patients, has flaws and can involve many false positive results, experts said. A transvaginal ultrasound, often ordered when an ovarian tumor is suspected, may not detect small but still potentially dangerous growths. But experts are hopeful that proteomics -- a sophisticated blood test in which protein fragments are analyzed to see if a pattern exists that is predictive of ovarian cancer -- might one day prove accurate enough to warrant widespread use.
Because of these and other obstacles, "the survival rate for ovarian cancer is still very low and unacceptable," said Lance A. Liotta, co-director of the Center for Applied Proteomics and Molecular Medicine at George Mason University's Prince William Campus, which is involved in ovarian cancer research. Fewer than half of ovarian cancer patients live more than five years after diagnosis, according to the ACS. When cancer is diagnosed and treated before it spreads outside of the ovary, the five-year survival rate jumps to 90 to 95 percent, but only 19 percent of ovarian cancers are found at that early stage.
Most cases -- about 51 percent -- are diagnosed at stage III, when the cancer has spread into other abdominal tissues and lymph nodes. This is the stage at which King's cancer was diagnosed.
"The prognosis for women with advanced ovarian cancer is very poor, with five-year survival rates drastically falling for stage II when the cancer has spread" into the abdominal cavity and beyond, according to the Web site of the Johns Hopkins Department of Pathology.
Stage II cancers -- which make up about 10 percent of ovarian cancers -- have five-year survival rates ranging from 51 percent to 69 percent. Stage IV cases, in which cancer has spread to the liver and outside of the abdomen, have a five-year survival rate of 12 percent.
Most ovarian cancers are epithelial cancers, meaning they start in the cells that line the outside of the ovary. The other two types are germ cell cancer (it starts in egg cells) and stromal cell cancer, a very uncommon form that begins in cells that make female hormones and hold the ovary together.
While ovarian cancer is more common in white women, the survival rate is lower in black women, according to the Ovarian Cancer National Alliance. The stage at which the cancer is diagnosed accounts for much of this disparity, said Russell Hill, director of gynecologic oncology at Howard University Hospital. Sometimes a patient "will end up waiting until it's too late" before seeking treatment, he said. "Access [to care] has a lot to do with why" African American women "tend to do worse." ·
News wires contributed to this report.