Ovarian cancer symptoms, routes to diagnosis and survival – Population cohort study in the ‘no screen’ arm of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Abstract

Objective There are widespread efforts to increase symptom awareness of ‘pelvic/abdominal pain, increased abdominal size/bloating, difficulty eating/feeling full and urinary frequency/urgency’ in an attempt to diagnose ovarian cancer earlier. Long-term survival of women with these symptoms adjusted for known prognostic factors is yet to be determined. This study explored the association of symptoms, routes and interval to diagnosis and long-term survival in a population-based cohort of postmenopausal women diagnosed with invasive epithelial tubo-ovarian cancer (iEOC) in the ‘no screen’ (control) UKCTOCS arm. Methods Of 101,299 women in the control arm, 574 were confirmed on outcome review to have iEOC between randomisation (2001–2005) and 31 December 2014. Data was extracted from medical notes and electronic records. A multivariable model was fitted for individual symptoms, time interval from symptom onset to diagnosis, route to diagnosis, speciality, morphological Type, age at diagnosis, year of diagnosis (period effect), stage, primary treatment, and residual disease. Results Women presenting with symptoms listed in the NICE guidelines (HR1.48, 95%CI1.16–1.89, p = 0.001) or the modified Goff Index (HR1·68, 95%CI1·32–2.13, p < 0.0001) had significantly worse survival than those who did not. Each additional presenting symptom decreased survival (HR1·20, 95%CI1·12–1·28, p < 0.0001). In multivariable analysis, in addition to advanced stage, increasing residual disease and inadequate primary treatment, abdominal pain and loss of appetite/feeling full were significantly associated with increased mortality. Conclusions The ovarian cancer symptom indices identify postmenopausal women with a poorer prognosis. This study however cannot exclude the possibility of better outcomes in those who are aware and act on their symptoms.

Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States

“…Our finding that the majority of women with an eventual diagnosis of ovarian cancer had 1 of the classic symptoms included on a validated symptom screening index speaks to the importance of having a high index of suspicion for ovarian cancer, even when these symptoms may not be the primary reason for a visit. Even though the absolute differences in TTD in our study were often small, even small differences in TTD may affect cancer survival, 14,19,22 and efforts should be taken to minimize any delays in diagnosis.…”

“…Studies suggest that the mean time from the onset of ovarian cancer symptoms to diagnosis ranges from 1.4 to 10.0 months and depends on the type and number of symptoms, route to diagnosis, and diagnostic workup. 2,[14][15][16][17] However, these reports are largely small observational studies or have been conducted internationally and thus represent dissimilar health care systems in comparison with the United States. Although controversial, [18][19][20][21][22] recent studies have suggested that a faster TTD may positively affect cancer survival.…”

“…Although controversial, [18][19][20][21][22] recent studies have suggested that a faster TTD may positively affect cancer survival. 14,19,22,23 Thus, understanding the factors affecting the time to an ovarian cancer diagnosis in the United States could not only elucidate gaps in the diagnostic workup of ovarian cancer but also provide actionable targets to improve ovarian cancer detection and care.…”

Women’s Awareness Of Ovarian Cancer Risk Factors And Symptoms In Western Iran In 2020-2021

“…Additionally, some symptoms of ovarian cancer may be confused with those of benign and more prevalent diseases, which can prevent timely visits for medical treatments (23). Early visits to medical centers after observing any symptoms of ovarian cancer can be associated with better therapeutic outcomes (24). In this study, 7.7% of participants stated that they will wait several months before visiting a medical center if they suspect the warning signs of ovarian cancer, and 10.8% of them said that they would never seek medical care.…”

“…Such studies are of special importance because the warning signs of ovarian cancer can be confusing for women. Because symptoms such as abdominal pain, anorexia, and a constant sense of fullness have been reported to be associated with the increased mortality risk (24), it is critical to raise women's awareness of the warning signs of ovarian cancer. The lowest level of awareness about risk factors was related to IVF treatment history (21.3%) and the application of talcum powder to the genital area (25.4%).…”