Only a quarter of women who present to their GP with symptoms of ovarian cancer are urgently referred to a gynaecologist, a general practice study has found.

A study from the South West of England looked at the pathways and time scales involved in a group of women identified with ovarian cancer. A total of 212 cases of ovarian cancer were identified over an eight-year period from 39 general practices in Devon.

In 92% of cases, either an abdominal mass or one of seven symptoms common in ovarian cancer (abdominal bloating, distension or pain, post-menopausal or rectal bleeding, anorexia, urinary frequency) was present.

Sixty five were referred to a gynaecologist, only 49 urgently, 58 to another specialist (most commonly a surgeon or gastroenterologist) and 35 for ultrasonography, 22 urgently.

A further 39 were admitted as emergencies and another two appear to have been internal gynaecological referrals.

Analysis of time scales showed that the overall median time from first presentation with symptoms in primary care and histological confirmation of disease was 74.5 days. Time from presentation in primary care to referral or organisation of a diagnostic test was actually pretty quick with median delays of 0 days for gynaecological and 2 days for radiological referral (inter-quartile ranges 0-22 and 1-15 days respectively). For those referred to a gynaecologist the average time between first presentation and histological diagnosis was 79 days. There was a suggestion that histological diagnosis was achieved more quickly in women referred for ultrasound scanning or admitted as an emergency, although the urgency of presentation for the latter may have expedited intervention.

Overall five-year survival in ovarian cancer is only 35%. However, women who are diagnosed with early disease have an 80-90% survival rate compared with 25% in those diagnosed in the later stages. Recent publicity has suggested that part of the sinister reputation of ovarian cancer is caused by GPs not spotting the disease early. These data suggest that most cases are in fact identified quickly in primary care. However, the non-specific nature of disease symptoms means the preferred route of urgent gynaecological referral is not followed in the majority of cases. Much of the delay between first presentation and diagnosis occurs after the GP referral.

In the absence of a useful screening test a high index of suspicion in primary care and urgent referral of cases to the appropriate hospital unit is vital.

Dr Chris Barclay