In addition, when TVS and symptom analysis are combined, the ability to distinguish benign tumors is improved, but detection of malignancy is worsened.

Although ovarian cancer has been perceived as a ‘silent killer’ that produces few specific symptoms, recent studies have indicated that certain symptoms are significantly more common in women with ovarian cancer than in women in the general population, Dr. Edward J. Pavlik, from the University of Kentucky, Lexington, and colleagues note. Exactly how symptom analysis stacks up against TVS was unknown.

Dr. Pavlik’s team collected data from 272 women who participated in annual TVS screening to assess the performance of TVS and symptom analysis in predicting ovarian cancer. Symptom survey published in 2007 was used in analyzing the symptoms.

In detecting ovarian cancer, TVS had a higher sensitivity (73.3%) than symptom analysis (20%) where as in distinguishing benign tumors, the specificity of symptom analysis was higher (91.3%) than that of TVS (74.4%).

When both TVS and symptom analysis were combined, the sensitivity in detecting ovarian cancer decreased to 16.7%, while the specificity in distinguishing benign tumors rose to 97.9%.

Until an effective screening test for ovarian cancer is found, the clinical challenge remains how to discriminate between significant and common symptoms to best care for patients, Dr. Ilana Cass, from Cedars-Sinai Medical Center, Los Angeles, comments in an accompanying editorial. Given the vague nature of these symptoms that lack an exact threshold for further costly evaluation, this is no small task.