Older women with suspected ovarian cancer 'face referral delays'
Older women with suspected ovarian cancer are often not referred for investigation as quickly as younger women, new research suggests.
Researchers at the Brighton and Sussex Medical School, funded by the Wellcome Trust, carried out a study of electronic patient records contained in the General Practice Research Database (GPRD).
They identified recorded diagnoses of ovarian cancer and compared them against rates in the UK cancer registries to see whether older and younger patients were managed differently by their GPs.
The results, which are published in the British Journal of Cancer, show that between 2002 and 2006, GPs were less likely to refer older women for investigation by a gynaecologist.
While 82 per cent of under-55s had undergone further investigation in the 12 months before their diagnosis, the figure fell to 75 per cent for 55 to 69-year-olds and just 66 per cent for the over-70s.
The researchers also observed that GPs were slower to refer elderly women than middle-aged patients.
Women aged 45 to 69 were typically referred within ten weeks of visiting their GP, whereas those aged between 75 and 79 years usually waited for 20 weeks before seeing a specialist.
Lead author Dr Rosemary Tate commented: "Ovarian cancer is a relatively rare disease but, as with all cancers, early diagnosis is important for improving the chances of successful treatment.
"Our research suggests that age plays a role in how quickly diagnosis and referral occurs - the older the patient, the later this appears to happen."
Dr Tate noted that the team had not looked at other types of cancer, but that if the results hold true for other forms of the disease, "such delays could be an important cause of avoidable illness and mortality".
She added that the trend "could contribute to the lower survival rates and higher mortality rates experienced in the UK", whose survival rates for cancer - particularly among older people - are among the lowest in Europe and have barely improved over the past ten years.
The researchers also noticed differences between the rates of recorded diagnoses of ovarian cancer in the GPRD database and those recorded in UK cancer registries.
Professor Jackie Cassell emphasised the importance of understanding why these discrepancies occur, adding: "This will help ensure that the information available to our health services is accurate and fit for purpose."
Sara Hiom, director of health information at Cancer Research UK, commented: "Ovarian cancer symptoms can be vague and suggestive of other, less serious conditions. But it's important that the disease is diagnosed at the earliest possible stage, whether the patient is young or old, as it is then easier to treat and there is a better chance of survival.
"Ovarian cancer is more common in older women, with four out of five cases in women over 50, so it's concerning if these older women are indeed less likely to be investigated.
"All too often cancer is found at a late stage, which is why we're working with the Department of Health, NHS and others on the National Awareness and Early Diagnosis Initiative (NAEDI) to address this problem.
"These results reinforce the importance of NAEDI's work, which includes raising public awareness of cancer, promoting earlier presentation and supporting doctors with the most up-to-date evidence and decision support."
- Tate, A., Nicholson, A., & Cassell, J. (2010). Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database British Journal of Cancer DOI: 10.1038/sj.bjc.6605593