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Authors have used red flag symptoms e.g. abdominal distension, weight loss, post-menopausal bleeding etc for exclusion criteria at the time of recruitment. Development of these symptoms in follow-up were taken as outcome variable as well. Author should also have done a bi-manual examination, an ultrasound and estimation of CA-125 for exclusion of ovarian cancer at recruitment and its development in the follow-up for estimating the validity and measurement of risk factors (along with red flag symptoms). Very surprisingly authors have not used ultrasound and bi-manual examination in the study, which would have been handy and valid.
I read your article with great interest and find the idea of getting useful information about identifying potential ovarian cancer cases out of the computer very enticing.
As a gynaecologist having been trained in artificial reproduction techniques, I am quite convinced that a history of ovarian stimulation and puncture (which means an injury to the ovarian epithelium) also is a risk factor for developing ovarian cancer. These interventions may have occurred many years earlier in life, so general practitioners might forget to ask for this special item of a woman's history, but the computer will be able to reproduce the fact (provided that the woman still keeps in contact with the same doctor, of course). What about testing this potential predictor in your algorithm as well?
Yours sincerely,
Dr. Susanne Bauer
Competing interests:
No competing interests
07 February 2012
Susanne Helene Bauer
gynaecological consultant
Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen
Re: Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm
Authors have used red flag symptoms e.g. abdominal distension, weight loss, post-menopausal bleeding etc for exclusion criteria at the time of recruitment. Development of these symptoms in follow-up were taken as outcome variable as well. Author should also have done a bi-manual examination, an ultrasound and estimation of CA-125 for exclusion of ovarian cancer at recruitment and its development in the follow-up for estimating the validity and measurement of risk factors (along with red flag symptoms). Very surprisingly authors have not used ultrasound and bi-manual examination in the study, which would have been handy and valid.
Competing interests: No competing interests