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Ovarian cyst risks
Title:Complex ovarian cysts in postmenopausal women are not associated with ovarian cancer risk factors
Author: P. Hartge, et al.
Address: Bethesda, Maryland
Source: American Journal of Obstetrics and Gynecology 183:1232-1237 (November) 2000
Summary: In the US, for patients with ovarian cancer the five-year relative survival rate is 47%. The survival rate varies from 93% in localized disease to a mere 28% in disease with distant metastases. Therefore, it is believed that the discovery of ovarian cancer through screening offers promise if otherwise deadly cancers can be identified earlier and treated more successfully. This study evaluated whether asymptomatic ovarian abnormalities detected on ultrasonography in postmenopausal women are precursors to ovarian cancer. Cysts were distinguished with the suggestive characteristics of a septum, a solid component, or an irregular or thick wall (complex cysts) from simple sonolucent cysts with none of those characteristics. The findings were suggestive of cancer if either ovarian volume exceeded 10 cm3 or if any solid area, papillary projection, or mixed solid-cystic component was seen. Some type of morphologic abnormality was found in 21% of the women. A complex cyst was found in 5% of the women and 16% had only simple sonolucent cysts with no solid component, no septum, and a smooth, thin wall. Researchers found that complex cysts were less prevalent in women of high parity, but age, oral contraceptive use, and family cancer history were not related to occurrence. Researchers concluded that only a small portion of the clinically silent ovarian abnormalities found on ultrasonography are determined to be ovarian cancers. The rest of the complex cysts and other clinically suspicious abnormalities don't appear to be the immediate precursors of ovarian cancer. However, the eventual identification of such precursors will yield opportunities for earlier diagnosis, screening of high-risk groups, and better understanding of the cause of their often deadly malignancy.
Comment: The debate remains, "is it better to know" about a benign cyst with routine ultrasound and operate, or turn away and wait until some women will return with advanced ovarian cancer.