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Study reveals inadequate treatment given for ovarian cancer

Dawn Brazell | News Center | May 3, 2013

Dr. Whitney GraybillMUSC gynecologic oncologist Whitney Graybill, M.D., wants women to know the latest research about why ovarian cancer is known as a silent killer.

When study results hit the national press recently that nearly two-thirds of ovarian cancer patients fail to receive recommended treatment that could extend their lives, MUSC physician Whitney Graybill wasn’t surprised.

Having double certifications in gynecology and oncology, Graybill is one of only two female specialists in the state with the designation of gynecologic oncologist. Her partner at the Medical University of South Carolina, Jennifer Young Pierce, is the other.

She was glad to see the publicity, and will be observing the first World Ovarian Cancer Day May 8, when cancer organizations worldwide will unite to educate their communities about ovarian cancer and its symptoms. Observations and studies such as the recent one that hit the national press help raise awareness and empower patients, she said.

“The results were very eye opening and disturbing,” Graybill said. “This should give us pause, and we need to figure out how to fix it. If this were breast cancer, it wouldn’t be happening.”

Graybill knows the statistics and the outcomes for patients who don’t get the care that meets clinical practice guidelines set by the National Comprehensive Cancer Network. In the study, it was found the risk of dying within five years of follow-up was 30 percent greater compared to women who got recommended treatment, according to researcher Dr. Robert Bristow, director of gynecologic oncology at the School of Medicine of the University of California, Irvine.

Annually more than 15,000 women die of ovarian cancer, with about 22,000 new cases of ovarian cancer being diagnosed in the nation, according to the American Cancer Society.

For the study, Bristow and his colleagues analyzed the treatment for more than 13,000 women with ovarian cancer, using data reported to the California Cancer Registry from 1999 through 2006. Half the women studied were younger than 61, and the majority, 70 percent, had advanced cancer. The researchers examined how many women got treatment as recommended by the cancer network, an alliance of 21 cancer centers that develops treatment guidelines.

Only 4,952, or 37 percent, got the recommended treatment.

Graybill, who handles many referrals, prefers to see patients before they have surgery. She has handled referral cases where she’s had to go back in because the patient didn’t initially receive an adequate cancer surgery.

“We know the importance of removing all of the cancer initially. Considerable evidence indicates that the volume of disease left at the completion of the primary surgery is related to patient survival.  We’re willing to be very aggressive up front because we know the outcomes are compromised if we’re not.”

The recommended guidelines specify combinations of surgery and chemotherapy, depending on the patient’s stage of disease, including debulking surgery to remove all visible tumors and aggressive chemotherapy to help prolong life, she said. Ovarian cancer spreads along the surface of the lining of the abdomen and pelvis. It can occasionally invade other areas, but most often does not.

Ovarian cancer kills more women than all other gynecological malignancies combined, she said. She wants to see physicians better educated about the latest recommended treatments and patients become empowered to make better choices.

“It comes down to educating women about the importance of taking control of their bodies and knowing the signs and symptoms of ovarian cancer. Women should insist on being sent to the appropriate subspecialist to ensure they will receive high-quality, comprehensive care for this aggressive cancer. Women should feel empowered to ask a surgeon, ‘How many of these cases have you done?’ If it’s two to three cases a year, that’s probably not good enough.”

She practices the only surgery subspecialty that treats its own oncology, which she loves as it allows her to develop deep bonds with patients as she walks them through every stage of their care, she said. A multitude of studies have found that women, particularly with ovarian cancer, have better outcomes when treated by gynecologic oncologists. In the hands of a general surgeon or obstetrician-gynecologist, only about 70 percent of patients with early-stage, high-risk disease will receive chemotherapy, but with gynecologic oncologists, more than 90 percent of these patients receive recommended treatment, she said. Some physicians without subspecialty training may not appreciate the risk of recurrence and failure in this aggressive cancer.

“It’s a matter of survival. There really are no good screening tests for ovarian cancer, which means three-fourths of women who have the disease have progressed to more advanced stages before diagnosis. These are all patients who need expert care.”

She hopes the study will spark discussion.

“The publicity is good to raise awareness about ovarian cancer. Hopefully, we’ll get more women the standard of care they deserve.”


Ovarian cancer is difficult to detect, especially in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:

•  Bloating
•  Pelvic or abdominal pain
•  Trouble eating or feeling full quickly
•  Feeling the need to urinate urgently or often

Other symptoms of ovarian cancer can include:

•  Fatigue
•  Upset stomach or heartburn
•  Back pain
•  Pain during sex
•  Constipation or menstrual changes

If symptoms persist for more than 2 weeks, ask your physician for a combination pelvic/rectal exam, transvaginal ultrasound, and CA-125 blood test.

Ovarian Cancer risk factors

  • Genetic predisposition
  • Personal or family history of breast, ovarian or colon cancer
  • Increasing age
  • Undesired infertility

    Source: National Ovarian Cancer Coalition




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Dr. Whitney Graybill
Dr. Whitney Graybill

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