The rules have changed again. The American College of Physicians published new guidelines for pelvic exams. Because this issue is near and dear to me, it brings up feelings. My feelings go something like: “but how do we have any chance of detecting ovarian cancer early if there’s no annual pelvic exam?” Ovarian cancer is already the deadliest of the gyno cancers because there is no test; no screen; no imaging that can definitively identify cancerous ovaries. There are symptoms, and every time I see a PSA telling me to be aware of the 4 symptoms in order to prevent ovarian cancer, I want to scream. Partly because if you have symptoms caused by cancer, then you already have the cancer, and therefore prevention is no longer possible. Mostly because the symptoms are ridiculously ambiguous (bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; urinary symptoms (urgency or frequency)). I’m the only Stage II I know. I didn’t notice any of those symptoms. The women I met at chemo who had had symptoms were diagnosed Stage III.