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Routine Care Fails to Aid Ovarian Cancer Detection in Older Women


 

PALM SPRINGS, CALIF. — Routine medical care and comprehensive health insurance coverage seem to improve the early detection of epithelial ovarian cancer in women aged 59 and younger, but not in those aged 60 and older, Dr. Sherry H. Weitzen reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“It surprised me that there was very little effect of access to care for older women in terms of being diagnosed at an earlier stage,” Dr. Weitzen, an epidemiologist in the obstetrics and gynecology department at Brown University, Providence, R.I., said in an interview.

“I was disappointed because … it seems like older women are doomed to being diagnosed later. That's what the literature says anyway, and there seems to be no kind of help for them [even] if they are vigilant about their health care.”

Dr. Weitzen and her associates reviewed the medical charts of 832 women diagnosed with epithelial ovarian cancer at Women and Infants Hospital in Providence between 1991 and 2004.

They used International Federation of Gynecology and Obstetrics (FIGO) standards to determine tumor stage during or after surgery, and defined health insurance as private/Medicare and Medicaid/uninsured/self-pay/none documented.

Of the 832 women, most (540) were diagnosed with late-stage disease, 82% were insured by Medicare or private insurance plans, and 66% reported having a “usual” care provider.

Of the 292 women diagnosed with early-stage disease, 71% reported having routine medical care, compared with 63% of their counterparts who were diagnosed with late-stage disease. In addition, 85% of women with early-stage disease had Medicare or private insurance, compared with 80% of women diagnosed with late-stage disease.

After adjusting for age at diagnosis, the researchers found that women who had routine medical care plus Medicare and/or private insurance were 1.74 times more likely to have ovarian cancer diagnosed at an early stage, compared with those who had no routine care and no other insurance plans.

“For women less than 60 years of age, the combined effect of having both routine care and better health insurance had two times the odds of earlier diagnosis, compared to women with no routine care and other health insurance,” the researchers wrote in their poster.

Dr. Weitzen said the study underscores the importance of early detection, noting that physicians “should encourage their patients to come in regularly.”

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