The study "Diagnostic Timing and Ovarian Cancer Survival in North Carolina" has been published in the latest issue of JAMA Network Open. Led by a team of UNC-Chapel Hill researchers, this study explored the relationship between survival and how quickly patients are diagnosed with ovarian cancer.
Ovarian cancer is hard to diagnose early. Its symptoms, like bloating and abdominal pain, are vague and similar to other more common conditions. Early diagnosis improves outcomes for many cancers. However, prior research suggests that faster diagnosis does not improve ovarian cancer survival, discouraging investments into better diagnostic tools. One possible explanation that could explain these prior findings is the "wait time paradox": the sickest patients are easier to diagnose quickly but also have poorer outcomes.
"This could be masking the benefits of early diagnosis and explain why faster diagnosis doesn't always appear to improve survival," said Sarah Soppe, MPH, the study's lead author and doctoral candidate at the UNC Gillings School of Global Public Health. "Taking into account how sick the patient appeared when they first saw the doctor could help address this methodological issue."
The team looked at the data of over 2,300 North Carolina women with ovarian cancer, such as patient characteristics, year of diagnosis and diagnostic interval—the time from a patient's first symptom-related clinic visit to diagnosis. Using flexible statistical methods, the team found a U-shaped pattern between diagnostic interval and survival: Women diagnosed very quickly and women diagnosed after long delays both had worse survival than those in the middle.
Patients diagnosed most quickly likely had symptoms severe enough that clinicians suspected cancer quickly, with poorer prognosis. Patients diagnosed most slowly also had high rates of advanced disease but may have had less obvious initial symptoms, leading to more medical visits and cancer progression before cancer was suspected. Patients in the middle intervals had the longest average survival times compared to shorter and longer intervals. These patients were diagnosed with fewer signs of advanced disease and were more likely to be younger, white and from higher-income neighborhoods—all factors linked to better access to care.
By considering how sick patients appeared, the study results suggest that earlier diagnosis of ovarian cancer may improve outcomes for some symptomatic patients, shedding light on the relationship between diagnosis time, severity of disease, and patient outcomes.
"The takeaway is that diagnostic delays may actually matter for ovarian cancer," said Caroline A. Thompson, PhD, the study's senior author who is an associate professor of epidemiology at the Gillings School and research fellow for the UNC Center for Health Promotion and Disease Prevention (HPDP). "Our hope is that these findings will encourage more research and investment into tools that improve diagnostic timing and outcomes for this aggressive cancer."
This work was supported by the UNC CDC Health Promotion and Disease Prevention Research Center and Ovarian Cancer Research Alliance ["A Mixed Methods Study of Diagnostic Delay in Ovarian and Uterine Cancer", HEG-2025-2-1900].
Caroline Thompson, PhD, MPH , is a research fellow for the UNC Center for Health Promotion and Disease Prevention (HPDP), an associate professor of epidemiology in the UNC Gillings School of Global Public Health, and a member of the UNC Lineberger Comprehensive Cancer Center.
