Women Under-Treated for Ovarian Cancer

By Kathleen Doheny
HealthDay Reporter
Monday, April 9, 2007 12:00 AM

MONDAY, April 9 (HealthDay News) -- Ovarian cancer is one of the most lethal cancers women can get, yet one out of three U.S. patients diagnosed with the disease doesn't get the full, recommended surgical treatment, a new study finds.

"It's very concerning that we see such a large proportion of women with ovarian cancer not being treated up to what we would consider a minimal standard for surgery," said the study's lead author, Dr. Barbara A. Goff, director of the division of gynecologic oncology at the University of Washington, Seattle.

Her team published the findings online April 9 in the journalCancer.

According to the American Cancer Society, ovarian cancer is diagnosed in about 24,000 women in the United States each year, and 14,300 die annually from the disease. The cancer typically shows few symptoms until it is diagnosed in its advanced stages.

The new study builds on previous research, Goff said.

"People [in previous studies] have looked at this on a state-by-state basis. What this study really did was look across a broad geographic area of the U.S. It gave us a good sense of what is happening in our country," she said.

"Minorities, women who live in low-income areas, elderly women [over 70] and those who live in rural areas are significantly less likely to get comprehensive care compared to those women who don't meet those [criteria]," according to Goff.

The Seattle team analyzed hospital data from up to nine states for the period between 1999 to 2002, looking at factors associated with comprehensive surgical care.

Only 67 percent of the 10,432 women whose cases were reviewed got the recommended comprehensive surgical procedures. A third of women were treated at a hospital that performed fewer than 10 ovarian cancer surgeries a year -- not at the high-volume facilities that are considered superior.

Almost half received treatment from a surgeon who performed fewer than 10 such procedures a year, not the best scenario for a good outcome. One-fourth got care from a doctor who did only one ovarian cancer surgery annually.

Much previous research has found that women who are treated by specialists -- in this case gynecologic oncologists -- have better survival, and that those who have complete removal of the tumor (which is more often done by a specialist) have better survival.

An opinion issued by the American College of Obstetricians and Gynecologists in 2002 stressed the importance of referral to a gynecologic oncologist if ovarian cancer is suspected. A U.S. National Institutes of Health consensus panel issued similar recommendations on comprehensive surgery for ovarian cancer more than a decade ago.

Another expert said the study confirms the importance of seeing a gynecologic oncologist, as the ACOG opinion recommends.

"It matters who does the surgery," said Dr. Ilana Cass, director of the gynecologic oncology fellowship program at Cedars-Sinai Medical Center, Los Angeles, and a gynecologic oncologist.

The new study, she added, has more complete numbers than previous research.

The experts' prime advice for women diagnosed with ovarian cancer or suspected ovarian cancer: Seek out a specialist.

That's easier said than done, however, they added. The problem, Goff said, is that the diagnosis is usually made at the time of surgery. If ovarian cancer is even suspected, she said, women should seek a referral to a center with a high volume of ovarian cancer surgeries, performed by a specialist.

She defines "high volume" as 10 or more such surgeries per year. If a woman cannot find a center that does 10-plus procedures, finding a center and a physician that does at least more than one a year is next-best option. "Those doctors who did 2 to 10 ovarian cancer surgeries were significantly better than those who did only one," Goff noted.

Cass agreed that asking to be referred to a high-volume center and to be seen by a physician who is a gynecologic oncologist are both good steps.

"Women have to be advocates for themselves," she said.

More information

To learn more about ovarian cancer, visit the American Cancer Society.

SOURCES: Ilana Cass, M.D., director, gynecologic oncology fellowship program, Cedars-Sinai Medical Center, Los Angeles; Barbara Goff, M.D., director, division of gynecologic oncology, University of Washington, Seattle; April 9, 2007, online edition,Cancer

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