A study found that symptom-triggered testing for ovarian cancer led to early-stage diagnosis in 25.2% of women with high-grade serous ovarian cancer (HGSOC), the most lethal subtype.
Published in the International Journal of Gynecological Cancer, the prospective study analyzed data from 1,741 women recruited through the UK's fast-track diagnostic pathway, which expedites specialist evaluation within 2 weeks for women with symptoms suspicious for ovarian cancer. The findings highlight the potential of this pathway to identify women with HGSOC at an early stage, when they have good performance status and low disease burden.
Among the 1,741 participants, 119 (6.8%) were diagnosed with HGSOC, at a median age of 63 years. Notably, 30 (25.2%) were diagnosed at stage I or II. Additionally, 112 (94.1%) had a good performance status of 0 or 1, and the extent of disease was low to moderate in 77 (64.7%). The study, part of the larger ROCkeTS (Refining Ovarian Cancer Test accuracy Scores) project, involved 24 UK hospitals and detailed clinical and histopathological data collection.
Women presenting with symptoms concerning for ovarian cancer underwent sequential CA125 testing and transvaginal ultrasound. Those with abnormal results on either test were referred through the fast-track pathway. Among the 215 women diagnosed with primary ovarian cancer via the fast-track pathway, 206 (95.8%) had epithelial tumors, 6 (2.8%) had sex cord-stromal tumors, and 3 (1.5%) had germ cell tumors. Of the 206 epithelial tumors, 119 (57.8%) were HGSOC, while the remaining malignancies were determined to be other subtypes, including mucinous (12.6%), endometrioid (10.2%), clear cell (7.9%), and low-grade serous (7.4%).
In women with HGSOC, the extent of disease was low (confined to pelvis and retroperitoneum) in 43 (36.1%), moderate (extending to mid-abdomen) in 34 (28.6%), and high (upper abdominal spread) in 32 (26.9%). Data were not available for 10 (8.4%) patients. Among women with HGSOC, 78 (65.5%) underwent primary debulking surgery, 36 (30.3%) received neoadjuvant chemotherapy followed by interval debulking surgery, and 5 (4.2%) did not undergo surgery. The disease was deemed inoperable in nine (7.6%) women. Of the 110 women with stage IC HGSOC or higher, 92 (83.7%) received chemotherapy while 16 (14.5%) did not. Data were not available for two (1.8%) patients.
Although the study primarily focused on the fast-track pathway, it also recruited women from outpatient clinics (n = 692, 26.7%) and emergency presentations (n = 163, 6.3%). However, the number of women with HGSOC in these groups was not large enough to draw meaningful comparisons.
The study had several strengths, including its prospective multicenter design, detailed data collection, and focus on real-world outcomes following implementation of symptom-triggered testing. Limitations included potential selection bias favoring healthier participants. However, the authors believe the findings related to HGSOC remain valid.
These results support the role of the fast-track diagnostic pathway in improving outcomes for women with ovarian cancer, potentially offering a model for other health systems, concluded researchers.
Declarations for competing interest can be found in the study.