Two in five women with ovarian cancer are diagnosed only after an emergency hospital admission, when they are 3 times less likely to have early stage and potentially curable disease, finds a data analysis published in the open access journal BMJ Oncology.
And rates of diagnosis after an emergency admission are even higher among women who are young, old, frail, or who live in areas of deprivation, the findings indicate.
Ovarian cancer is the eighth most common female cancer worldwide, taking the lives of more than 200,000 women every year, note the researchers, who add that it's not easy to diagnose, because it shares several symptoms with common benign conditions.*
In a bid to improve earlier diagnosis, the researchers set out to identify key factors associated with the risk of an ovarian cancer diagnosis within 28 days of an emergency hospital admission.
They drew on national cancer registry data for all 28,204 adult women diagnosed with the disease in England between 1 January 2017 and 31 December 2021, which were then linked to hospital admission records.
Between January 2017 and December 2021, 11,377women—just over 40% of the total number—were diagnosed within 28 days of an emergency hospital admission.
Certain factors were associated with the highest risk: frailty; youth; old age; and economic deprivations.
Among the 3372 women who were very frail, denoted by a SCARF index of "severe frailty", more than two thirds (2313; nearly 69%) were diagnosed after an emergency admission. This compares with 2891 (29%) of the 9912 women who weren't categorised as frail (SCARF index of "fit").
Diagnosis after an emergency admission was also 36% more likely in 18 to 29 year olds (209 of 490; 43%), and 25% more likely in older (80+) women (2952 of 5379; 55%) than it was among women in their 60s (2319 of 6402; just over 36%).
"The risk of being diagnosed with ovarian cancer after an emergency admission was higher in younger women, despite having higher rates of early stage low grade…cancers—factors associated with lower rates of ovarian cancer diagnosis following emergency admission," highlight the researchers, possibly because ovarian cancer isn't regarded as a young woman's disease, they speculate.
Similarly, women from the most deprived neighbourhoods were 11% more likely to be diagnosed after an emergency admission (2377 of 5823; just over 44%) than those from the least deprived (2367 of 6261; 38%), even after accounting for influential factors, such as age and frailty.
Disease diagnosed following an emergency admission was more likely to be advanced, the analysis showed. Among the 8438 women for whom information on stage was available, just 1155 (14%) had early stage (1 or 2) cancers compared with 5442 (just over 39%) of the 13,865 women who weren't diagnosed after an emergency admission.
Women diagnosed after an emergency admission were also 3 times less likely to have slow growing tumours (958 of 2224;14.5%) than women who weren't admitted as an emergency (2892 of 11,946; just over 24%).
This is an observational study, and no firm conclusions can be drawn about cause and effect, added to which, the researchers acknowledge various limitations to their findings. For example, they didn't have complete information on the presence of co-existing conditions and cancer stage and grade, nor did they have any information on the women's primary care use before admission.
There's likely to be an interplay of various patient and healthcare service factors behind the findings, all of which merit further investigation before outcomes for women with ovarian cancer can be improved, suggest the researchers.
But this isn't just a problem for England, they highlight: "The issue of ovarian cancer diagnosis following an emergency admission is not confined to England but also affects countries such as the USA, Australia, Denmark, Norway, Canada and New Zealand, where the rates range from about 20% to 50%," they point out.
"Concerted action, where possible with support from international collaborations, is needed to improve referral and diagnostic pathways, with a focus on increasing patient awareness, improving early recognition of alarm symptoms, handling the prioritisation of waiting lists, and developing efficient diagnostic pathways that can provide a timely service to the many women with non-specific symptoms," they conclude.
*Symptoms of ovarian cancer include:
persistent abdominal bloating, abdominal or pelvic pain, quickly feeling full when eating, loss of appetite, unexplained weight loss, fatigue, increased urinary frequency or urgency and changes in bowel habit
