As I See It
Ovarian Cancer - Is It Really A Silent Killer?
By Jill Chapin
Nov 26, 2006 - 5:55:00 PM

UNITED STATES—Have you ever heard of ovarian cancer described as the silent, deadly killer? Ever heard the lament that it's almost always discovered too late at Stage 3 or 4 and then, only in response to patients complaining of symptoms?

Yet the Ovarian Cancer National Alliance says that early detection can improve survival rates from 25 to over 90 percent. So why aren't we finding more ovarian cancers at Stage 1 or 2?

The American Cancer Society advocates that women get an annual diagnostic mammogram—with no symptoms required—for potentially early detection of breast cancer before it progresses further. Why, then, doesn't the American Cancer Society also recommend use of a transvaginal ultrasound—with no symptoms required—for potentially early detection of ovarian cancer before it, too, progresses further?

A transvaginal ultrasound is a mighty good way of discovering ovarian cancer before it becomes a fatal disease. Yet oddly, there is no voice—no shout, actually—for women to add this simple, painless procedure to their annual gynecological visit.

Why is that? It couldn't be because there could be false positives or that they could miss cancers that are there. If that were the reason, then who would bother with a mammogram? After all, mammograms also report false positives and can also fail to detect some cancers.

I suspect that the reason it is not recommended is more financial than medical. Insurance companies probably wouldn't pay for this added annual test. While it is always dangerous to base one's medical health on the fiscal needs of insurance companies, shouldn't women at least know this test is available? If women decide to forgo an extra night at the Holiday Inn on their next vacation, hold off on the purchase of a dress or a nice dinner out in order to afford this test, shouldn't that be their decision on how best to appropriate their money? Rich Gimpelson, a St. Louis gynecologist, believes that many women would pay for a test like this if they would just look at their health in the same way they look at their car maintenance.

So why aren't the various cancer organizations—and anyone who has ovaries or who loves someone who has them—simply alerting women to the potential life-saving benefit of this annual ultrasound? What could possibly be the downside of doing so?

A gynecologist recently told me that he purchased one of those ultrasounds ten years ago. He acknowledges that it is rare for a doctor to have one available to patients right in the examining room because they are expensive and it takes time to learn how to use it. Usually, patients are sent to an imaging center for an ovarian ultrasound only after presenting symptoms.

So I asked this doctor how many ovarian cancers he had found in the past ten years; his answer was six. Four were his patients who were seen annually all had Stage 1. The other two were referred to him with symptoms? They both had Stage 3.

What's so disconcerting about all of the above is that ovarian cancer is called the silent killer, even though a simple test could "hear" it before it begins to scream.

So why aren't more women yelling about this?

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