Question asked by: 
Date asked: 
Sep 2018

Symptoms of ovarian cancer are often the same symptoms that a menopausal woman may have so how can we get early diagnosis unless there is universal screening?

How can we get early diagnosis unless there is universal screening?
The tests we have are not reliable enough for a widespread screening programme.
Response by Joan - Target Ovarian Cancer Nurse Adviser

Menopause usually happens between the ages of 45-55, with 51 years being the average. Ovarian cancer is usually diagnosed in women aged 50 and over and the risk of developing ovarian cancer increases as a woman gets older. Most cases of ovarian cancer occur in women who have already gone through the menopause. More than half the cases of ovarian cancer diagnosed are in women over the age of 65 years.

However, menopausal symptoms vary from those of ovarian cancer. The main symptoms of menopause are caused by changes in oestrogen levels. Common symptoms that women can have are hot flushes, night sweats, mood changes and anxiety, joint stiffness, palpitations and sometimes recurrent urinary tract infections as well as irregular and decreasing periods. You can read more about the symptoms of menopause on the NHS Choices website.

Whereas, women are suspected of and are tested for ovarian cancer if they have symptoms like bloating, abdominal or pelvic pain, needing to pass urine more often and feeling full quickly. The symptoms usually get progressively worse and more persistent and happen on most days. Most of the symptoms are caused by the effects of the disease on the organs and structures in the abdominal cavity (tummy).

If women are worried that their symptoms are like those associated with ovarian cancer they should always discuss this with their GP.

It would be so helpful if there was a suitable screening programme available for ovarian cancer and researchers are working on this. However, at the moment the tests we have, which are the CA125 blood test and the transvaginal ultrasound (TVU), are not reliable enough to use for population screening. The CA125 blood level can rise in non-cancerous conditions (such as endometriosis and some lung problems) and unfortunately with about 20 per cent of ovarian cancers, it does not rise at all. Also, the TVU can find a mass or lump in the ovary but it can’t tell if it is cancer or not and most masses are non-cancerous.

Screening also has a negative side to it in that false alarms can cause unnecessary surgery to be carried out and there can sometimes be complications from surgery. Screening and false alarms can cause a lot of anxiety and that is why there is a need for a very reliable test, which we don’t yet have.

For some women regular screening with the CA125 and TVU tests may be appropriate because they have a genetic or family history which is known to give them a higher risk of developing ovarian cancer. That would then be decided on an individual basis with the woman’s doctors.

In the meantime, while we don’t have a general screening programme, awareness of the symptoms is very important.

More research is needed into whether a screening programme is feasible
Response by Rachel Downing - Head of Policy, Target Ovarian Cancer
Rachel Downing - Head of Policy

Early diagnosis is vital if more women are to survive ovarian cancer. That’s why at Target Ovarian Cancer we are working to raise awareness of the symptoms of the disease and to train GPs so that women are referred promptly for tests.

While everyone wants to see a screening programme for ovarian cancer, this can only go ahead if we know it will work.

UKCTOCS is a large-scale study which has been looking at the feasibility of a screening programme, and while early results showed some promise, the evidence is not yet there that a national screening programme would be effective.

Researchers are doing further work and are expected to report back in 2019, at which point we’ll know if a screening programme is possible with the current ovarian cancer tests we have. Until then we will continue working to raise awareness as well as investing in research that will hopefully lead to the better diagnostic tests we need to catch this disease sooner.