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.

This week the World Health Organization (WHO) released new guidelines recommending people switch the regular salt they use at home for substitutes containing less sodium.

But what exactly are these salt alternatives? And why is the WHO recommending this? Let’s take a look.

A new solution to an old problem

Advice to eat less salt (sodium chloride) is not new. It has been part of international and Australian guidelines for decades. This is because evidence clearly shows the sodium in salt can harm our health when we eat too much of it.

Excess sodium increases the risk of high blood pressure, which affects millions of Australians (around one in three adults). High blood pressure (hypertension) in turn increases the risk of heart disease, stroke and kidney disease, among other conditions.

The WHO estimates 1.9 million deaths globally each year can be attributed to eating too much salt.

The WHO recommends consuming no more than 2g of sodium daily. However people eat on average more than double this, around 4.3g a day.

In 2013, WHO member states committed to reducing population sodium intake by 30% by 2025. But cutting salt intake has proved very hard. Most countries, including Australia, will not meet the WHO’s goal for reducing sodium intake by 2025. The WHO has since set the same target for 2030.

The difficulty is that eating less salt means accepting a less salty taste. It also requires changes to established ways of preparing food. This has proved too much to ask of people making food at home, and too much for the food industry.

Enter potassium-enriched salt

The main lower-sodium salt substitute is called potassium-enriched salt. This is salt where some of the sodium chloride has been replaced with potassium chloride.

Potassium is an essential mineral, playing a key role in all the body’s functions. The high potassium content of fresh fruit and vegetables is one of the main reasons they’re so good for you. While people are eating more sodium than they should, many don’t get enough potassium.

The WHO recommends a daily potassium intake of 3.5g, but on the whole, people in most countries consume significantly less than this.

Potassium-enriched salt benefits our health by cutting the amount of sodium we consume, and increasing the amount of potassium in our diets. Both help to lower blood pressure.

Switching regular salt for potassium-enriched salt has been shown to reduce the risk of heart disease, stroke and premature death in large trials around the world.

Modelling studies have projected that population-wide switches to potassium-enriched salt use would prevent hundreds of thousands of deaths from cardiovascular disease (such as heart attack and stroke) each year in China and India alone.

The key advantage of switching rather than cutting salt intake is that potassium-enriched salt can be used as a direct one-for-one swap for regular salt. It looks the same, works for seasoning and in recipes, and most people don’t notice any important difference in taste.

In the largest trial of potassium-enriched salt to date, more than 90% of people were still using the product after five years.

Making the switch: some challenges

If fully implemented, this could be one of the most consequential pieces of advice the WHO has ever provided.

Millions of strokes and heart attacks could be prevented worldwide each year with a simple switch to the way we prepare foods. But there are some obstacles to overcome before we get to this point.

First, it will be important to balance the benefits and the risks. For example, people with advanced kidney disease don’t handle potassium well and so these products are not suitable for them. This is only a small proportion of the population, but we need to ensure potassium-enriched salt products are labelled with appropriate warnings.

A key challenge will be making potassium-enriched salt more affordable and accessible. Potassium chloride is more expensive to produce than sodium chloride, and at present, potassium-enriched salt is mostly sold as a niche health product at a premium price.

If you’re looking for it, salt substitutes may also be called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.

A review published in 2021 found low sodium salts were marketed in only 47 countries, mostly high-income ones. Prices ranged from the same as regular salt to almost 15 times higher.

An expanded supply chain that produces much more food-grade potassium chloride will be needed to enable wider availability of the product. And we’ll need to see potassium-enriched salt on the shelves next to regular salt so it’s easy for people to find.

In countries like Australia, about 80% of the salt we eat comes from processed foods. The WHO guideline falls short by not explicitly prioritising a switch for the salt used in food manufacturing.

Stakeholders working with government to encourage food industry uptake will be essential for maximising the health benefits.

Xiaoyue (Luna) Xu, Scientia Lecturer, School of Population Health, UNSW Sydney and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health

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