Abstract
OBJECTIVE: To compare time to diagnosis of the typically slow-growing Type I (low-grade serous, low-grade endometrioid, mucinous, clear cell) and the more aggressive Type II (high-grade serous, high-grade endometrioid, undifferentiated, carcinosarcoma) invasive epithelial ovarian cancer (iEOC).
DESIGN: Multicentre observational study.
SETTING: Ten UK gynaecological oncology centres.
POPULATION: Women diagnosed with primary EOC between 2006 and 2008.
METHODS: Symptom data were collected before diagnosis using patient questionnaire and primary-care records. We estimated patient interval (first symptom to presentation) using questionnaire data and diagnostic interval (presentation to diagnosis) using primary-care records. We considered the impact of first symptom, referral and stage on intervals for Type I and Type II iEOC.
MAIN OUTCOME MEASURES: Patient and diagnostic intervals.
RESULTS: In all, 78% of 60 Type I and 21% of 134 Type II iEOC were early-stage. Intervals were comparable and independent of stage [e.g. median patient interval for Type I: early-stage 0.3 months (interquartile range 0.3-3.0) versus late-stage 0.3 months (interquartile range 0.3-4.5), P = 0.8]. Twenty-seven percent of women with Type I and Type II had diagnostic intervals of at least 9 months. First symptom (questionnaire) was also similar, except for the infrequent abnormal bleeding (Type I 15% versus Type II 4%, P = 0.01). More women with Type I disease (57% versus 41%, P = 0.04) had been referred for suspected gynaecological cancer. Median time from referral to diagnosis was 1.4 months for women with iEOC referred via a 2-week cancer referral to any specialty compared with 2.6 months (interquartile range 2.0-3.7) for women who were referred routinely to gynaecology.
CONCLUSION: Overall, shorter diagnostic delays were seen when a cancer was suspected, even if the primary tumour site was not recognised to be ovarian. Despite differences in carcinogenesis and stage for Type I and Type II iEOC, time to diagnosis and symptoms were similar. Referral patterns were different, implying subtle symptom differences. If symptom-based interventions are to impact on ovarian cancer survival, it is likely to be through reduced volume rather than stage-shift. Further research on histological subtypes is needed.
TWEETABLE ABSTRACT: No difference in time to diagnosis for Type I versus Type II invasive epithelial ovarian cancers.
| Original language | English |
|---|---|
| Pages (from-to) | 1012-20 |
| Number of pages | 9 |
| Journal | BJOG |
| Volume | 123 |
| Issue number | 6 |
| Early online date | 29 May 2015 |
| DOIs | |
| Publication status | Published - May 2016 |
Keywords
- Aged
- Aged, 80 and over
- Delayed Diagnosis
- Early Detection of Cancer
- Female
- Humans
- Medical Records
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial
- Ovarian Neoplasms
- Primary Health Care
- Referral and Consultation
- Retrospective Studies
- Surveys and Questionnaires
- Symptom Assessment
- Time Factors
- Journal Article
- Multicenter Study
- Observational Study
- Research Support, Non-U.S. Gov't
