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The American College of Physicians recommended Monday that doctors refrain from doing internal pelvic exams on nonpregnant adult women with no symptoms of disease. As an ovarian cancer survivor, I strongly disagree.
There is no reliable screening test for early detection of ovarian cancer, which is why 81 percent of women found to have the disease aren't diagnosed until it is in its advanced stages, when fewer than half survive. Until an effective screening test is developed, we need to use every tool we have, including cost-effective, quick-response pelvic exams.
Every year, 22,000 women are diagnosed with ovarian cancer, and 15,000 die from the disease. Sadly, these numbers have remained about the same for decades. Ovarian cancer is the most lethal of the gynecologic cancers and the fifth leading cause of cancer deaths in American women.
Ovarian cancer was known for years as the “silent killer” because it was thought that there were no recognizable symptoms. In 2007, research led by Barbara Goff at the University of Washington School of Medicine found that there are identifiable symptoms of ovarian cancer. These include:
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Urinary frequency or urgency
It is still too easy for women or health-care providers to dismiss these symptoms as common, benign signs of middle-aged life. But if a woman experiences any of them for 12 days in a month, she should seek medical attention. Pelvic exams are important diagnostic tools that help determine whether referral to a gynecologic oncologist is advisable. Prompt medical attention to symptoms can result in early detection of cancer before it spreads.
I know because I was one of the lucky few who was diagnosed with Stage One ovarian cancer. Although I was asymptomatic, my gynecologist suspected ovarian cancer during a routine pelvic exam when she felt lumps on one of my ovaries.
I was 51 years old. She knew to refer me immediately for follow-up testing, which includes a CA 125 blood test, a transvaginal ultrasound and a CT scan. (Although the CA 125 test is a useful diagnostic tool, it is not reliable for general screening.) Ovarian cancer can only be diagnosed definitively with surgery, so within a month I had a hysterectomy. Both my ovaries, including the one that had appeared healthy in preoperative imaging, had malignancies.
Only in hindsight did I realize that I had been experiencing vague symptoms prior to visiting my gynecologist. I don’t think I exaggerate when I say that her perceptive care, based on an internal pelvic exam, saved my life.
Pelvic exams may create some discomfort and embarrassment, as the American College of Physicians suggests. But it sure beats the alternative.
JoAnn Symons is chairwoman of the Ovarian and Gynecologic Cancer Coalition/Rhonda’s Club in Arlington, Va.