Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care

Objective To identify the routes patients with ovarian cancer take between first symptom presentation and diagnosis. Design Cohort study. Setting The study took place in 39 general practices in Devon, UK. Population All ovarian cancer patients identified in the practices, with a diagnosis between 2000 and 2007 inclusive. Methods All patients had their cancer symptoms, referrals, and diagnoses identified and dated using their doctors' records. Main outcome measures Numbers of patients taking specific routes to diagnosis, together with the time taken to diagnosis. Results Three main routes to diagnosis emerged. The first was the expected route of outpatient referral: 195 (92% of the total) had at least one of the seven ovarian cancer symptoms or an abdominal mass. A total of 123 (58%) were referred to a specialist, although only 65 (31%) were referred to a gynaecologist. Thirty-five (17%) were initially investigated within primary care by ultrasound scanning, and a further 35 (17%) were admitted as emergencies. The interval from first symptom to referral was similar across the different pathways, with a median (interquartile range) time between the first symptom presenting to primary care and first investigation or referral being 2.5 (0, 27.5) days. The median interval from first symptom reported in primary care to diagnosis was 74.5 (32, 159) days. Conclusions Only a minority of ovarian cancer patients follow the expected route to diagnosis, of urgent referral to a gynaecologist. In most women, GPs rapidly identified the need to investigate. Avoidable delays generally occurred after the decision to investigate was made.