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Ovarian Cancer Risk Lower With Regular Medical Care


BOSTON -- Women who put off regular pelvic exams have a nearly fourfold increase in the risk of ovarian cancer, according to researchers here.

BOSTON, March 27 -- Women who put off regular pelvic exams have a nearly fourfold increase in the risk of ovarian cancer, according to researchers here.

The risk of ovarian cancer was 3.9 times higher among women who didn't have regular pelvis exams during the five years before diagnosis than among matched controls, found Haim Abenhaim, M.D., of the Harvard School of Public Health, now at Sainte-Justine Hospital in Montreal.

In the case-control study, the risk of ovarian cancer was also markedly higher among women who did not see a doctor regularly or have a regular health-care provider, Dr. Abenhaim and colleagues reported in the March issue of the Canadian Medical Association Journal.

The risks were also sharply higher for post-menopausal women with poor or non-existent medical care, the researchers reported.

While the reasons for the association remain unclear, Dr. Abenhaim and colleagues said, "women should be encouraged to maintain regular medical care."

Interestingly, when the analysis was adjusted to account for "potential intermediates in the causal pathway," such as smoking and the use of contraceptive pills, the association was attenuated but not eliminated, the researchers said.

Dr. Abenhaim and colleagues enrolled 668 women diagnosed with ovarian cancer in Massachusetts and New Hampshire from July 1998 through July, 2003 and compared them with 721 matched controls.

The time period of interest was the five years before a reference day, which was a year before diagnosis for the cases and a year before the interview for controls.

The study found:

  • Women who did not have a medical visit during the time period had nearly three times the risk of cancer, with an odds ratio of 2.8 (which fell to 2.4 upon adjustment for potential causal intermediates).
  • Women who did not have a pelvic examination had an odds ratio for cancer of 3.9, which fell to 2.9 upon adjustment for intermediates.
  • Women who had no regular health care provider had an odds ratio for cancer of 2.7, which fell to 2.2 upon adjustment.
  • Despite the adjustment for potential intermediates, all the odds rations remained statistically significant.

The increased risk was most pronounced among women who were postmenopausal, with no medical visit leading to an odds ratio of 7.7, no pelvic examination giving an odds ratio of 3.3, and no health care provider yielding an odds ratio of 12.5, the researchers said.

The study had the usual limitations of a case-control study, the researchers noted, including the possibilities of confounding and selection bias.

While ovarian cancer is a devastating disease, "the conclusion of the present study should be viewed cautiously," said Michael Fung-Kee-Fung, M.D., of the Ottawa Hospital in Ottawa, Ontario, writing in an accompanying commentary.

Dr. Fung-Kee-Fung and colleagues said that it's "premature" to translate the findings of the study into changes in clinical practice or policy.

Indeed, they say, the evidence so far from systematic reviews is that no interventions in routine screening reduce the risk of ovarian cancer among asymptomatic low-risk women.

"We certainly do not object to women receiving yearly medical and pelvic examinations," Dr. Fung-Kee-Fung and colleagues said. "However, the utility of this intervention should not be misinterpreted as a strategy to reduce the risk of ovarian cancer."

They concluded that "better patient outcomes would be seen if efforts were directed toward improving compliance with promising treatment modalities, rather than trying to advance practice in areas where the totality of evidence suggests there is no benefit."

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