BACKGROUND.Currently, screening for ovarian cancer is not recommended for the general population. Targeting women with specific symptoms for screening has been evaluated only recently, because it was believed that symptoms had limited specificity.METHODS.A case‐control study of 149 women with ovarian cancer, including 255 women who were in a screening program and 233 women who were referred for pelvic/abdominal ultrasound, was conducted by inviting women to complete a survey of symptoms. Patients were divided randomly into an exploratory group and a confirmatory group. Symptom types, frequency, severity, and duration were compared between cases and controls. Logistic regression analyses were used to determine which factors independently predicted cancer in the exploratory group and then were used to develop a symptom index, which was tested for sensitivity and specificity in the confirmatory group.RESULTS.Symptoms that were associated significantly with ovarian cancer were pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full when they were present for <1 year and occurred >12 days per month. In a logistic regression analysis, symptoms that were associated independently with cancer were pelvic/abdominal pain (P < .001), increased abdominal size/bloating (P<.001), and difficulty eating/feeling full (P = .010). A symptom index was considered positive if any of those 6 symptoms occurred >12 times per month but were present for <1 year. In the confirmatory sample, the index had a sensitivity of 56.7 for early‐stage disease and 79.5% for advanced‐stage disease. Specificity was 90% for women age >50 years and 86.7% for women age <50 years.CONCLUSIONS.Specific symptoms in conjunction with their frequency and duration were useful in identifying women with ovarian cancer. A symptom index may be useful for identifying women who are at risk. Cancer 2007. © 2006 American Cancer Society.

BACKGROUND Colon carcinoma is a common malignancy that accounts for a substantial share of all cancer‐related morbidity and mortality. However, little is known with regard to general and disease specific quality of life in survivors of colorectal carcinoma, particularly from community‐based samples of cases across stage and survival times from diagnosis. METHODS Subjects with colorectal carcinoma were recruited from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry. Subjects completed two self‐administered surveys: the Functional Assessment of Cancer Therapy Scales for Colorectal Cancer (FACT‐C) and the Health Utilities Index (HUI) Mark III. RESULTS One hundred seventy‐three respondents (average age: 70.4 years, 71.4% female) completed the survey. In the first 3 years after diagnosis, quality of life was lower and varied substantially among respondents. After 3 years, respondents in all TNM stages of disease except Stage IV reported a relatively uniform and high quality of life. Pain, functional well‐being, and social well‐being were affected most substantially across all stages and times from diagnosis. Low income status was associated with worse outcomes for pain, ambulation, and social and emotional well‐being. Only emotional well‐being scores improved significantly over time in both surveys. CONCLUSIONS Those individuals who achieve a long term remission from colorectal carcinoma may experience a relatively high quality of life, although deficits remain for several areas, particularly in those of low socioeconomic status. Sampling design may have excluded the most severely ill patients. Cancer 2000;88:1294–1303. © 2000 American Cancer Society.

Those who achieve long term remission from colorectal cancer may experience a relatively high QOL, although physical symptoms such as diarrhea and depressive symptoms remain a problem.

As screening and treatment for breast cancer improve, learning about survivors' post-treatment needs becomes increasingly important. Focus groups (n = 23) were conducted with breast cancer survivors (n = 128) in rural Washington communities during a 5-month period in 1996 to explore ways to improve the lives of rural breast cancer survivors and to expand existing knowledge of breast cancer survivorship. Survivors reported positive and negative outcomes of their cancer experience. Results indicate that the needs of many women with breast cancer, particularly women diagnosed with late-stage disease, are not being met. Participants diagnosed with late-stage cancer were more likely than participants diagnosed with early-stage cancer to comment about being treated poorly by the medical system and to voice a need for increased support and educational services for breast cancer patients. Rural survivors, regardless of stage at diagnosis, reported needing more education about breast cancer and more emotional support after diagnosis. Further efforts to facilitate support and education within the context of medical care and to improve patient-clinician relationships are needed.

BACKGROUND Prior studies suggest that combining the Symptom Index (SI) with a serum HE4 test or a CA125 test may improve prediction of ovarian cancer. However, these three tests have not been evaluated in combination. METHODS A prospective case-control study design including 74 women with ovarian cancer and 137 healthy women was used with logistic regression analysis to evaluate the independent contributions of HE4, CA125, and the SI to predict ovarian cancer status in a multivariate model. The diagnostic performance of various decision-rules for combinations of these tests was assessed to evaluate potential use in predicting ovarian cancer. RESULTS The SI, HE4, and CA125 all made significant independent contributions to ovarian cancer prediction. A decision-rule based on any one of the three tests being positive had a sensitivity of 95% with specificity of 80%. A rule based on any two of the three tests being positive had a sensitivity of 84% with a specificity of 98.5%. The SI alone had sensitivity of 64% with specificity of 88%. If the SI index is used to select women for CA125 and HE4 testing, specificity is 98.5% and sensitivity is 58% using the 2-of-3-positive decision rule. CONCLUSIONS A 2-of-3-positive decision rule yields acceptable specificity, and higher sensitivity when all 3 tests are performed than when the SI is used to select women for screening by CA125 and HE4. If positive predictive value is a high priority, testing by CA125 and HE4 prior to imaging may be warranted for women with ovarian cancer symptoms.

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A number of longitudinal studies have explored the role of friends', parents', and older siblings' smoking in children's smoking acquisition. A reasonable implication of this previous research is that intervention efforts could be beneficially directed toward countering the potential influence of friends' and possibly older siblings' smoking but not parents' smoking. However, methodological limitations of this previous research motivated our reevaluation of the role of friends', parents', and older siblings' smoking in children's smoking. Close friends' smoking status was assessed when children were in 5th grade, whereas parents' and older siblings' smoking status was assessed when children were in 3rd grade. The outcome, children's daily smoking status, was assessed in 12th grade. The setting was 40 Washington state school districts that participated in the long-term Hutchinson Smoking Prevention Project. Participants were the 4,576 families for whom close friends', parents', and older siblings' smoking status as well as children's smoking status were available. The probability that each close friend's smoking influenced the child to smoke daily was 9% (95% CI = 6%-12%), the probability that each parent's smoking influenced the child to smoke daily was 11% (95% CI = 9%-14%), and the probability that each older sibling's smoking influenced the child to smoke daily was 7% (95% CI = 1%-13%). These results suggest that close friends', parents', and siblings' smoking were similarly important influences on children's smoking. Family-focused interventions could be a valuable future direction of prevention research.

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