Abstract
BACKGROUND. Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS. Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS. From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS. Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1398-1407 |
| Number of pages | 10 |
| Journal | Cancer |
| Volume | 104 |
| Issue number | 7 |
| DOIs | |
| State | Published - Oct 1 2005 |
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Keywords
- Epidemiology and End Results
- Medicare
- Ovarian cancer detection
- Ovarian cancer symptoms
- Surveillance
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
Ovarian cancer : Can we make the clinical diagnosis earlier? / Smith, Lloyd H; Morris, Cyllene R.; Yasmeen, Shagufta; Parikh-Patel, Arti; Cress, Rosemary D; Romano, Patrick S.
In: Cancer, Vol. 104, No. 7, 01.10.2005, p. 1398-1407.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ovarian cancer
T2 - Can we make the clinical diagnosis earlier?
AU - Smith, Lloyd H
AU - Morris, Cyllene R.
AU - Yasmeen, Shagufta
AU - Parikh-Patel, Arti
AU - Cress, Rosemary D
AU - Romano, Patrick S
PY - 2005/10/1
Y1 - 2005/10/1
N2 - BACKGROUND. Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS. Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS. From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS. Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.
AB - BACKGROUND. Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS. Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS. From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS. Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.
KW - Epidemiology and End Results
KW - Medicare
KW - Ovarian cancer detection
KW - Ovarian cancer symptoms
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=25144441133&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=25144441133&partnerID=8YFLogxK
U2 - 10.1002/cncr.21310
DO - 10.1002/cncr.21310
M3 - Article
C2 - 16116591
AN - SCOPUS:25144441133
VL - 104
SP - 1398
EP - 1407
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 7
ER -