Monday, September 18, 2023

The Latest: Advancement in Early Detection of Ovarian Cancer

According to the Society for Women's Health Research, Over 20,000 women will be diagnosed with ovarian cancer this year in the United States and women have a 92% chance of surviving for five years post-diagnosis. However, more than three-fourths of women are not diagnosed until later stages." [1] Abnormal ovaries are often benign simple cysts, however the complex cysts are classifiable with the new ultrasound scoring system as to how suspicious they may be. The same way we detect prostate tumors by routine yearly ultrasound screening in high risk patients, we could save many lives because sometimes the first sign of ovarian cancer is a gland in the neck that pops up, a mass under the arm or jaundice because the liver is filled with metastatic tumor.


Historically, the risk of ovarian cancer is linked to the current state of diagnostic technology. Though mortality rates have decreased over the years, cases of ovarian cancers may still reach critical stages when they are detected too late.  This happens because early ovarian cancer is commonly hard to feel on a routine pelvic exam. In addition, by the time it spreads, it fills the abdominal cavity with metastatic fluid, making it difficult to palpate. 

In 1980, I gave a talk for the American College of Obstetricians at Memorial Sloan Kettering Cancer Center where we presented the use of real-time imaging for the instantaneous documentation of the fetal heart beat by intrauterine cardiac sonogram to detect fetal demise instead of waiting 2 weeks to see if the fetus was growing. We asserted a similar use of ultrasound technology to monitor abnormal ovarian cysts as small as two centimeters (2-3 cm is about the size of a normal ovary). Early cancers could not be felt, but are imaged with ultrasound as the technology advanced. With today's high resolution and 3D imaging, (including endo probes with elastography for the uterus and ovaries) recent upgrades offer even better capabilities to conduct regular screening in real time called a  noninvasive “virtual biopsy”.

In the 1990's, advancements in imaging allowed us to accurately detect prostate cancer, uterine cancer, and particularly see abnormal ovarian tumors. In addition, there is now an entire classification of ovarian cysts promoted by all the ultrasound and gynecologic societies to discern the fact that not all cysts are suspicious while some will be cancerous. Most of the ovarian cancers have cystic components. In my history as a practitioner, the first possible indicator of ovarian cancer was the swollen belly. Oftentimes, patients would come in after a CT for abdominal distension might show a fluid-filled abdomen, malignant ascitic fluid- and then when they drained the fluid, you might find an ovarian cancer tumor that metastasized to the lymph nodes, the mesentery membrane (the wall around the stomach area) or the liver. 

Today's 3D imaging not only finds tumors that could be cancerous as small as 3cm, but we are also able to detect and look at suspicious lesions. While 3cm is considered sizable in the ultrasound field, it's not big in the gynecologic field because that's about the size of an average tumor. Ultrasound technology is now able to see three millimeter cancers in the glands, which we have been doing for the past 10 years

Instead of conducting biopsies on abnormal glands, we now employ the sonogram in areas like the axillary lymph nodes. If there is an abnormal gland with a tumor under ultrasound guidance we insert a tiny biopsy needle and aspirate cells for cytology, which are contemporaneously analyzed microscopically providing timely diagnosis and reduced patient anxiety from waiting and often avoids the risks of a full dissection of the axillary or groin lymph node.

Thanks to modern endo probes that can scan deeper organs, we study micrometastatic nodules throughout the body in superficial areas and in deeper areas like the ovary. The endo probes resolution is 5x greater than the MRI or the CT scanner.  It is able to see not only the size and the irregularity in the cancerous wall of a cyst, but it measures the blood flow, which gives you a number of the abnormal tumor vessels in a cancer. Measuring the number of cancerous arteries indicates the severity of an ovarian tumor would be. Similarly, the fewer feeding blood vessels, the less malignant it is likely to be. 

With our current 3D screening solutions, we now have a way to find cancers before they metastasized throughout the body. And we have the technology that can be used to study a cyst instead of doing a exploratory laparotomy to take out a suspicious ovary. 


1) "Ovarian Cancer: Outdated Diagnostics for a Deadly Disease" Society for Women's Health Research- Feb 4, 2020.

Public Service Announcement

From the publishers of ANGIO-RESEARCH, THE WELLNESS JOURNAL and the WOMEN'S DIAGNOSTIC NETWORK NEWS comes a consortium of IPHA'S top professional contributors in women's health & wellness advocacy. Subscribe to our latest community E-news forum and get the insiders news on pain therapeutics, diagnostics and lifestyle upgrades. We welcome special guest contributors from all modalities of healing - from practitioners, product innovators and researchers. Also, gain valuable insight from success stories of real people and their experience with WHAT WORKED for them! Check back with us soon to get front row access to our latest headlines. Visit: 

Over a decade after Gilda Radner’s passing in May of 1989, Dr. Nancy Cappello (a startlingly similar case of professional inefficiency and neglect) was diagnosed with stage 3C breast cancer in 2004 from a mis‐read mammogram, concealed behind dense breast tissue. A false negative mammography scan unidentified a large 2.5 cm suspicious lesion, which was later found via ultrasound readings was confirmed to be stage 3c breast cancer. This same cancer had metastasized to 13 lymph nodes. This sparked Dr. Cappello to create the "Are You Dense?" Foundation‐ an international awareness crusade to better support dense breast diagnostics and initiatives pass legislation to enact laws requiring mammography centers to inform patients about their breast density and the associated cancer risks.

Dr. Cappello passed away on Nov 15, 2018, from secondary myelodysplastic syndrome (MDS), a bone marrow cancer that was a complication of her prior aggressive breast cancer treatments. But she ignited a legacy of fighting for improved policies, advancing imaging technologies and continued research to better address this health crisis that puts the est. 40% of the female population (women with dense breasts) at risk of a false negative readings or other dense‐breast related cancers. The disorder or the cause may vary, but sad endings to stories like these remain common in our patient community.  We stand at a major point in history when medicine offers the highest advancements in technological innovations and treatment options- if not for HUMAN ERROR, or the mis-management of those entrusted to give professional care.    (See reprised feature from 10/2021 @:


By: Dr. Noelle Cutter

For most of America (or the many parents), September and the fall season means "Back to School and Back to work" from a summer of exhaustive and adventurous travels. But for another audience, the cancer awareness crusaders have a dedicated calendar for awareness months where the fall season may have the most cancers represented.  According to the AACR (American Association for Cancer Research), the Fall calendar is comprised of a major set of public awareness programs promoted by dedicated cancer foundations.  September's calendar alone has the following events for awareness months: Childhood Cancer, Leukemia and Lymphoma, Ovarian Cancer, Prostate Cancer, Thyroid Cancer and Uterine Cancer.  Meanwhile BREAST CANCER AWARENESS MONTH stands in October as the top event.

Recognizing the link between having Dense Breast tissue and the potential risk for Breast Cancer is what drives advocacy groups like the "Are You Dense?" Foundation.  Prompting a national education project is a decades-old mission that cancer docs and patient advocates alike are in a constant search for action-plans.  For the reasons why Breast Cancer continues to capture the heart of the battle within a national Awareness Month, the community now has DENSE BREAST AWARENESS WEEK as the last week if September to transition to Breast Cancer Month of October. 

Recent talks of a grassroots campaign to approach colleges about Dense Breast Awareness is in the works, according to  Heidi Diaz, communications consultant for the "Are You Dense?" Foundation.  Additionally, more clinicians are 'joining the fight' in support of the research including Dr. Roberta Kline (OB/GYN) who applauds the recent legislation in Congress to mandate clinical communication  in Mammography centers about patients' tissue density.  "This is the pathway to employing other imaging solutions like a supplemental ultrasound which clearly sees through dense tissue where mammography underperforms".

National Recognition in Dense Breast Research and Awareness

WOODBURY, Conn., Sept. 15, 2023 /PRNewswire/ -- Joseph Cappello, founder of the 'Are You Dense?' Foundation presented the first in a series of Cancer Research & Innovations awards to diagnostic imaging specialist Dr. Robert Bard (NYC).  Since 1979, Dr. Bard's radiology practice spearheaded the use of ultrasound screening to complement scheduled mammograms for those with dense breast tissue. (It is noted that ultrasound scans are able to detect growths and tumors behind dense tissue, what mammograms tend to miss). At the time, no regulatory standard enforced the need for this 2nd scan, attributing to many undetected breast cancer tumors concealed by dense breast tissue.

Joseph Cappello, founder of the "Are You Dense?" Foundation honors cancer researcher & clinical diagnostic specialist Dr. Robert Bard (NYC) with the first Cancer Research & Innovations Award.  This award recognizes clinical leadership in the advancement of early detection protocols and the improved screening of dense breast cases.

Joseph Cappello, founder of the "Are You Dense?" Foundation honors cancer researcher & clinical diagnostic specialist Dr. Robert Bard (NYC) with the first Cancer Research & Innovations Award. This award recognizes clinical leadership in the advancement of early detection protocols and the improved screening of dense breast cases.

"Decades since the advent of breast scanning technology, a growing list of real-time innovations in non-invasive diagnostic imaging provide new options in the field of early detection", states Dr. Bard. "These technologies directly align with breast density screening that can easily complement a woman's regular mammogram.  By updating the imaging process, we can safely combine diagnostic modalities and improve the assessment of disease and guide therapeutic procedures."

According to a 12/13/2022 press release, Congresswoman Rosa DeLauro (CT-03), Congressman Brian Fitzpatrick (PA-01), and award-winning journalist Katie Couric introduced their legislation, the Find It Early Act. This bill would ensure all health insurance plans cover screening and diagnostic mammograms and breast ultrasounds and MRIs with no cost-sharing.  (See full news release)

"Dr. Bard will go down in medical history as one of the earliest change-makers in our crusade to improve women's early detection programs.  His innovative approach to combine technologies makes him a true visionary for the next generation of cancer professionals... by standing his ground about the crisis and aiding in (what is now) a national legislation to save more lives!", states Mr. Cappello.


In 2014, Imaging Technology News (ITN) introduced breast cancer survivor-turned-crusader Dr. Nancy Cappello and her story about having dense breast tissue leading to a late-stage cancer.  A false negative mammography scan (diagnosed in 2004) concealed a large 2.5 cm suspicious lesion, which was later confirmed to be stage 3c breast cancer. Dr. Cappello created the "Are You Dense?" Foundation to better support dense breast diagnostics and to pass legislation and laws requiring mammography centers to inform patients about their breast density and the associated cancer risks. Dr. Cappello passed away on Nov 15, 2018, from secondary myelodysplastic syndrome (MDS), a bone marrow cancer that was a complication of her prior aggressive breast cancer treatments.  Her legacy continues to help address this health crisis that puts the est. 40% of the female population (women with dense breasts) at risk of a false negative readings.

Are You Dense, Inc. pursues the national mission to educate the public about the risks and screening challenges of dense breast tissue and its impact on missed, delayed and advanced stage breast cancer to reduce advanced disease and mortality.  

Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc., The AngioFoundation-501c3 and Bard Diagnostic Research & Educational Programs). It is provided strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.


HOW EFFECTIVE ARE STRATEGIES TO LOWER PSA READINGS?   By: Dr. Roberta Kline PSA, or prostate-specific antigen, is a protein produced by pros...