[Abstract] Time to diagnosis for ovarian cancer in England: associations with 'alternative explanation' comorbidities and recent menopause

Introduction: Ovarian cancer is diagnosed at a late-stage 3/4 in the majority (62%) of patients resulting in poor survival and high morbidity and mortality. Several factors, i.e., biological, patient/healthcare system-related, and socioeconomic factors contribute to delayed diagnosis of ovarian cancer. This also include lack of specific “alarm symptoms”, and cancer symptoms are often attributed to chronic conditions especially irritable bowel syndrome, recurrent urinary tract infections or menopause-related changes.

Material and method: Patients in England born before 1955 and diagnosed with incident ovarian cancer between 1990 and 2019 were identified in the Clinical Practice Research Datalink (CPRD) Gold and CPRD Aurum databases and linked hospital admission and cancer registry data. ‘Diagnostic interval’ (or time to diagnosis) was defined as time from first presentation in primary care with a relevant sign/symptom to diagnosis. Associations between presenting sign/symptom, comorbidities offering “alternative explanations” for symptoms, and recent menopause and diagnostic interval were investigated using multivariable linear regression models adjusting for patient characteristics including age, presence of other comorbidities and consultation frequency. Models were run for Gold and Aurum databases separately, and results combined using meta-analysis.

Result and discussion: Complete data were available for 2010 patients in CPRD Gold and 1885 patients in CPRD Aurum. Presenting sign/symptom was associated with substantial variation in diagnostic interval. Compared to patients presenting with abdominal or pelvic pain, diagnostic interval was 125% higher in patients with back pain, and 63% higher for patients with urinary symptoms, but was substantially reduced (i.e., halved) in patients presenting with abdominal mass, distension or ascites. The diagnostic interval was also increased by 27% in women with two or more “alternative explanation” comorbidities versus those with none, and by 32% among women with recent menopause.

Conclusions: Our study provides evidence that ovarian cancer diagnosis may be delayed in women with chronic conditions such as irritable bowel syndrome and/or menopause-related symptoms/changes. Raising awareness of this possibility (i.e., symptom ambiguity) among primary care physicians may reduce the number of late-stage diagnosis, improve survival and reduce morbidity and mortality from ovarian cancer.