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Concerns Over New Ovarian Cancer Test

When British researchers reported recently on a new method for early detection of ovarian cancer, gynecologists’ offices were flooded with telephone calls. Women wanted to know where they could get the special ultrasound test.

Consciousness about ovarian cancer is at an all-time high, thanks partly to “thirtysomething’s” television dramatization of Nancy Weston’s battle with the disease and to the 1989 death of actress Gilda Radner. The cancer, expected to kill 12,000 American women this year, can be difficult to diagnose until it’s in advanced stages and often grows quickly.

Now, some experts are concerned that the new ultrasound method--which is becoming more widely available--will be overused by women at low risk for the cancer. In Southern California, the technique is now available at, among other sites, UCLA, Long Beach Memorial Medical Center and some private physicians’ offices. Physicians at other major hospitals say they are looking into the possibility of obtaining the technology.

Experts also worry that physicians not sufficiently trained in ultrasonography will buy a unit. And some emphasize that, as promising as transvaginal ultrasonography, is, it is still considered investigational.

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Dr. S. B. Gusberg, a member of the Gynecologic Task Force of the American Cancer Society said Monday that transvaginal ultrasonography is “not yet demonstrated better than pelvic exams at detecting ovarian cancer in early stages. What we need is a good clinical trial.”

The new method employs an internal vaginal probe--which has been available for about three years--that can visualize the ovaries on the ultrasound screen much better than the traditional external abdominal probe. Some physicians combine the ultrasound test with Doppler blood flow imaging, which analyzes blood flow around the ovaries. “In the last year, research has suggested that ovarian tumors have distinctive blood flow,” said Dr. Michael Crade, medical director of the Long Beach Memorial Medical Center ultrasound department. Some physicians also use a special blood test to detect elevated levels of CA 125, a cancer cell byproduct.

Who should undergo the new test? Experts don’t agree. Some say use of the test, which generally costs $100 to $150, should be limited to high-risk women: Risk increases with age and is highest for women over age 60, according to the American Cancer Society. Also considered at risk are women with a family history of ovarian cancer, those who have never had children and those with a history of breast cancer.

For low-risk women, some experts contend, the traditional pelvic exam, in which a physician manually palpates the ovaries, is enough. “A good pelvic exam will pick up the majority of ovarian cancers,” said Dr. Edward Grant, professor of radiological sciences and chief of diagnostic ultrasound at the UCLA School of Medicine. For now, Grant believes transvaginal ultrasonography should be reserved for high-risk women. He points to a University of Kentucky study, in which 1,500 women, all age 40 or above and without enlarged abdomens or other warning signals of ovarian cancer, have been screened via transvaginal ultrasonography. Three cancers were detected. “Ovarian cancer is an uncommon disease,” Grant said. “And while we would like to detect it as early as possible, the best practical method for low-risk women is still a good pelvic examination.”

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In strong disagreement is Crade of Long Beach. He supports expanded use of ultrasound in routine screening for ovarian cancer. He points to his review of the medical records of 23 ovarian cancer patients. He found that more than half the patients with cancers smaller than 4 inches in diameter had false negative physical exams. “The pelvic physical exam has never been shown to be an effective screening tool in detecting early ovarian cancer in stage one, when it is curable,” Crade said. Ideally, Crade said, postmenopausal women should undergo ultrasound screening every one or two years; women with a family history might want to consider undergoing the test every six months.

“We’re very high on the technology,” added Dr. John R. Van Nagell Jr., the University of Kentucky researcher whose team has screened 1,500 women. “But its efficacy is not yet proven. This whole area is experimental for now.”

SHOP TALK Car Filter Helps Drivers Breathe Easy

Last month, Shell Oil announced the debut of its new low-polluting gasoline in nine cities, including Los Angeles, judged as having the most severe air quality problems. But it’s not the only new product for the health-conscious, ecologic-minded motorist. An Irvine company has just launched Filt-Aire, a $10 activated carbon auto filter designed to remove up to 90% of unhealthy hydrocarbons by filtering the air before it reaches the driver/passenger area. The filter, not usually visible when in place, is installed over the air intake vents--generally located under the hood between the windshield and the engine.

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“Filt-Aire not only reduces the toxins and pollutants like truck exhaust, but reduces dust and pollen, especially important for people with asthma or allergy problems,” said Jim Muhr, spokesman for Inspections System Engineering Inc., of Irvine.

It should be changed at least every 5,000 miles, he said.

“In principle, activated charcoal is good for cleaning the air,” said Robert Phalen, director of the Air Pollution Air Effects Laboratory at UC Irvine College of Medicine, who emphasizes the need to change such filters regularly. “Once it is loaded with pollutants, it can become a source of pollutants.”

Filt-Aire is sold at some car dealerships and some auto air conditioning service centers. For more information, phone (714) 583-7287.

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POINT COUNTERPOINT

At the Tone, Test Your Hearing

Up to 40% of Americans age 65 and older have some degree of hearing loss, according to the American Speech-Language-Hearing Assn. And hearing loss due to loud music and other environmental factors is becoming more prevalent in younger people.

To help detect hearing loss in the early stages, telephone tests have sprung up, sponsored by clinics, hospitals, service organizations and hearing aid dealers. In most tests, callers dial a number and follow directions to listen for specific tones. At the end, they’re advised to seek professional help if test results warrant it. The telephone tests are quick, easy and free. But they have sparked debate among audiologists and other hearing experts.

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Proponents claim the tests can help detect hearing loss early, thus preserving quality of life. Opponents question the accuracy of the tests and worry that they may give some people with hearing impairments a false sense of security. Here, two points of view on the value of telephone hearing tests.

Sandra Gordon-Salant, audiologist, associate professor of audiology, University of Maryland, College Park:

“At this time, I would not endorse the telephone hearing tests. We don’t know their effectiveness. They may be somewhat inaccurate and lead to confusion for consumers about whether they have a hearing loss. This procedure may miss someone with a significant hearing loss. As an example, someone with hearing loss may not hear the test instructions very well or the follow-up instructions (directing listeners to professional help if warranted).

“Many people with hearing loss have tinnitus (ringing in the ears). These people may think they are hearing tones but actually be hearing their own tinnitus. The conditions under which people take the test can affect results. Sometimes a telephone wire can have static. There could be background noise that could lead to inaccuracies. There are different types of telephones, and a different type could transmit the (test) signal differently. Even the same telephone could transmit the sounds differently at different times. Ideally, hearing tests should be given under controlled conditions with a known signal level.

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“The techniques may improve in the future. But for now, anyone suspecting a hearing loss should get a referral for an in-office hearing test by a qualified audiologist.”

Robert Sweetow, audiologist and director, San Francisco Hearing and Speech Center, a nonprofit organization:

“I’m not endorsing telephone hearing tests, but I do see a role for them. For example, consider a son who says to his aging mother, ‘Mom, you’re not hearing well.’ She answers, ‘I hear everything.’ The mother doesn’t want to see a doctor. So the son says, ‘OK, let’s try one of these phone tests.’ The mother is more likely to agree. Then if she doesn’t pass, she may be more amenable to the idea of seeing a doctor.

“If someone listens to a telephone hearing test and does not pass, they should not go directly to a hearing aid dealer. They should contact their physician to get a hearing test by a qualified audiologist.

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“If the test is used for the purpose of guiding people to professional help when needed, it’s good. But if the test is used as an advertising gimmick by a hearing aid dealer, it’s dangerous.”

For information on hearing loss, call the American Speech-Language-Hearing Assn.'s help line, (800) 638-TALK. For information on telephone hearing tests sponsored by Dial A Hearing Screening Test, call (800) 222-EARS.


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