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Symptoms, Diagnoses, and Time to Key Diagnostic Procedures Among Older U.S. Women With Ovarian Cancer

Ryerson, A Blythe MPH1; Eheman, Christie PhD1; Burton, Joseph MS2; McCall, Nancy ScD2; Blackman, Don PhD1; Subramanian, Sujha PhD2; Richardson, Lisa C. MD, MPH1

doi: 10.1097/01.AOG.0000260392.70365.5e
Original Research

OBJECTIVE: To examine the types of symptoms and diagnostic procedures reported in Medicare claims 12 months before diagnosis for women with ovarian cancer by stage, and to assess the association between types of symptoms and time to key diagnostic procedures.

METHODS: Medicare claims linked to records in the Surveillance, Epidemiology, and End Results (SEER) cancer registries were used to examine diagnosis and procedure codes in 3,250 women aged 65 years and older before a diagnosis of ovarian cancer.

RESULTS: Over 81% of women with ovarian cancer had at least one target sign or symptom before diagnosis. Gastrointestinal symptoms such as nausea and vomiting (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.40–2.98), and constipation, diarrhea, or other digestive disorders (aOR 2.01, 95% CI 1.58–2.56) were associated with later-stage cancer. In contrast, gynecologic symptoms such as abnormal bleeding (aOR 0.44, 95% CI 0.34–0.58) and genital organ pain (aOR 0.66, 95% CI 0.53–0.80) were associated with earlier disease. Among those with at least one symptom, the rate at which women with gynecologic symptoms went to surgery was higher (hazard ratio 5.5, 95% CI 5.1–6.0) than the rate for women with other nongastrointestinal ovarian cancer–related symptoms.

CONCLUSION: Women with ovarian cancer presenting with gastrointestinal symptoms were more likely to have later-stage disease and longer time to key diagnostic tests than those with gynecologic symptoms. Clinicians should be aware of the potential for unresolved gastrointestinal symptoms to be indicators for ovarian cancer.


Women with ovarian cancer and gynecologic symptoms are more likely to have early disease and receive key diagnostic procedures sooner than those with gastrointestinal symptoms.

From the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and 2Research Triangle Institute (RTI), International, Research Triangle, North Carolina.

The contributions of RTI were funded by the Division of Cancer Prevention and Control.

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

Presented at the 2nd North American Congress of Epidemiology, Seattle, Washington, June 21–24, 2006.

Corresponding author: A. Blythe Ryerson, MPH, 4770 Buford Highway, NE K-55, Atlanta, GA 30341; e-mail:

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.