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Pathways to the diagnosis of epithelial ovarian cancer in Australia
Author(s) -
Jordan Susan J,
Francis Jane E,
Nelson Anne E,
Zorbas Helen M,
Luxford Karen A,
Webb Penelope M
Publication year - 2010
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2010.tb03942.x
Subject(s) - medicine , referral , presentation (obstetrics) , cancer , ovarian cancer , population , abdominal pain , family medicine , gynecology , medical diagnosis , general surgery , obstetrics , pediatrics , pathology , environmental health
Objective: To describe the diagnostic pathways experienced by a large, representative group of Australian women with ovarian cancer, and to document the time between first presentation to a medical professional and clinical diagnosis. Design, setting and participants: 1463 women with epithelial ovarian cancer from an Australia‐wide population‐based study (2002–2005) completed a telephone interview in which they described the events that led to the diagnosis of their cancer. Main outcome measures: Number and type of doctors consulted, investigations performed, referral patterns and the time from first presentation to diagnosis. Results: Of the 1463 women, 145 had their cancer diagnosed incidentally and were excluded from analysis. Most of the remaining 1318 women (1222, 93%) presented first to their general practitioner. As a result of their first medical consultation, 75 women (6%) were given a diagnosis, and 484 (37%) were referred to a gynaecologist, gynaecological oncologist or oncologist for further assessment. Overall, 85% of women visited three or fewer doctors before their cancer was diagnosed; 66% of cancers were diagnosed within 1 month of the initial presentation, and 80% were diagnosed within 3 months. For 12% of women, the diagnostic process took longer than 6 months; this was more likely for women residing in remote Australia, those with lower incomes, and those presenting with abdominal pain or bowel symptoms, or with more than one symptom. Conclusions: Despite anecdotal suggestions to the contrary, most women with ovarian cancer in Australia are investigated and diagnosed promptly. The diagnostic process is more protracted for a minority of women, and the factors we found to be associated with diagnostic delay warrant further investigation.