Ovarian cancers are often found when they are already advanced and hard to treat.

Researchers have long believed this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be hard to identify as they’re vague and similar to other conditions.

But a new study shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist.

As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages.

So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly?

Why is ovarian cancer hard to detect early?

Ovarian cancer cannot be detected via cervical cancer screening (which used to be called a pap smear) and pelvic exams aren’t useful as a screening test.

Current Australian guidelines recommend women get tested for ovarian cancer if they have symptoms for more than a month. But many of the symptoms – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses.

This makes early detection a challenge. But it is crucial – a woman’s chances of surviving ovarian cancer are associated with how advanced the cancer is when she is diagnosed.

If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has already metastatised, meaning it has spread to other parts of the body.

If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%.

There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women failed to reduce deaths.

That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly.

What did the new study look at?

Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK.

They were asked to monitor for these four symptoms:

• persistent abdominal distension (women often refer to this as bloating)
• feeling full shortly after starting to eat and/or loss of appetite
• pelvic or abdominal pain (which can feel like indigestion)
• needing to urinate urgently or more often.

Women who reported at least one of four symptoms persistently or frequently were put on a fast-track pathway. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines.

Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound.

What did they find?

The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer.

A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths.

Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body.

There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%).

It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body.

What does this mean for detection?

The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates.

It also points to the importance of public awareness about symptoms.

Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue.

But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought.

This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient.

Many women remain unaware of the symptoms of ovarian cancer. This study shows recognising them may help early detection and treatment.

Jenny Doust, Clinical Professorial Research Fellow, Australian Women and Girls’ Health Research Centre, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do you struggle to eat your fruits and vegetables? You are not alone. Less than 5% of Australians eat the recommended serves of fresh produce each day (with 44% eating enough fruit but only 6% eating the recommended vegetables).

Adults should aim to eat at least five serves of vegetables (or roughly 375 grams) and two serves of fruit (about 300 grams) each day. Fruits and vegetables help keep us healthy because they have lots of nutrients (vitamins, minerals and fibre) and health-promoting bioactive compounds (substances not technically essential but which have health benefits) without having many calories.

So, if you are having trouble eating the rainbow, you might be wondering – is it OK to drink your fruits and vegetables instead in a juice or smoothie? Like everything in nutrition, the answer is all about context.

It might help overcome barriers

Common reasons for not eating enough fruits and vegetables are preferences, habits, perishability, cost, availability, time and poor cooking skills. Drinking your fruits and vegetables in juices or smoothies can help overcome some of these barriers.

Juicing or blending can help disguise tastes you don’t like, like bitterness in vegetables. And it can blitz imperfections such as bruises or soft spots. Preparation doesn’t take much skill or time, particularly if you just have to pour store-bought juice from the bottle. Treating for food safety and shipping time does change the make up of juices slightly, but unsweetened juices still remain significant sources of nutrients and beneficial bioactives.

Juicing can extend shelf life and reduce the cost of nutrients. In fact, when researchers looked at the density of nutrients relative to the costs of common foods, fruit juice was the top performer.

So, drinking my fruits and veggies counts as a serve, right?

How juice is positioned in healthy eating recommendations is a bit confusing. The Australian Dietary Guidelines include 100% fruit juice with fruit but vegetable juice isn’t mentioned. This is likely because vegetable juices weren’t as common in 2013 when the guidelines were last revised.

The guidelines also warn against having juice too often or in too high amounts. This appears to be based on the logic that juice is similar, but not quite as good as, whole fruit. Juice has lower levels of fibre compared to fruits, with fibre important for gut health, heart health and promoting feelings of fullness. Juice and smoothies also release the sugar from the fruit’s other structures, making them “free”. The World Health Organization recommends we limit free sugars for good health.

But fruit and vegetables are more than just the sum of their parts. When we take a “reductionist” approach to nutrition, foods and drinks are judged based on assumptions made about limited features such as sugar content or specific vitamins.

But these features might not have the impact we logically assume because of the complexity of foods and people. When humans eat varied and complex diets, we don’t necessarily need to be concerned that some foods are lower in fibre than others. Juice can retain the nutrients and bioactive compounds of fruit and vegetables and even add more because parts of the fruit we don’t normally eat, like the skin, can be included.

So, it is healthy then?

A recent umbrella review of meta-analyses (a type of research that combines data from multiple studies of multiple outcomes into one paper looked at the relationship between 100% juice and a range of health outcomes.

Most of the evidence showed juice had a neutral impact on health (meaning no impact) or a positive one. Pure 100% juice was linked to improved heart health and inflammatory markers and wasn’t clearly linked to weight gain, multiple cancer types or metabolic markers (such as blood sugar levels).

Some health risks linked to drinking juice were reported: death from heart disease, prostate cancer and diabetes risk. But the risks were all reported in observational studies, where researchers look at data from groups of people collected over time. These are not controlled and do not record consumption in the moment. So other drinks people think of as 100% fruit juice (such as sugar-sweetened juices or cordials) might accidentally be counted as 100% fruit juice. These types of studies are not good at showing the direct causes of illness or death.

What about my teeth?

The common belief juice damages teeth might not stack up. Studies that show juice damages teeth often lump 100% juice in with sweetened drinks. Or they use model systems like fake mouths that don’t match how people drinks juice in real life. Some use extreme scenarios like sipping on large volumes of drink frequently over long periods of time.

Juice is acidic and does contain sugars, but it is possible proper oral hygiene, including rinsing, cleaning and using straws can mitigate these risks.

Again, reducing juice to its acid level misses the rest of the story, including the nutrients and bioactives contained in juice that are beneficial to oral health.

So, what should I do?

Comparing whole fruit (a food) to juice (a drink) can be problematic. They serve different culinary purposes, so aren’t really interchangeable.

The Australian Guide to Healthy Eating recommends water as the preferred beverage but this assumes you are getting all your essential nutrients from eating.

Where juice fits in your diet depends on what you are eating and what other drinks it is replacing. Juice might replace water in the context of a “perfect” diet. Or juice might replace alcohol or sugary soft drinks and make the relative benefits look very different.

On balance

Whether you want to eat your fruits and vegetables or drink them comes down to what works for you, how it fits into the context of your diet and your life.

Smoothies and juices aren’t a silver bullet, and there is no evidence they work as a “cleanse” or detox. But, with society’s low levels of fruit and vegetable eating, having the option to access nutrients and bioactives in a cheap, easy and tasty way shouldn’t be discouraged either.

Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.