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Woman talking to a GPOver a quarter of women with ovarian cancer are diagnosed through Accident and Emergency and just one in three women are diagnosed with Stage I disease (where survival is highest).13,14,15

National guidelines set out how GPs should assess and refer women with symptoms that could be ovarian cancer. GPs should start by discussing the symptoms experienced by women and their frequency before carrying out a pelvic examination to check for a mass or ascites (fluid in the abdomen).

If a mass or ascites are found, GPs should make an urgent (two week wait) referral to a gynaecological oncologist.

In all other cases GPs should refer women for a CA125 blood test. If this shows raised levels of the CA125 protein, then women should be referred for an ultrasound (transvaginal and abdominal). (Except in Scotland where both the blood test and ultrasound are carried out at the same time.) If a mass is detected, women should be referred on to a gynaecological oncologist.16,17

Previous Pathfinders have found many mistaken beliefs held by GPs in regards to ovarian cancer. These include believing that it is a ‘silent killer’ and that symptoms only present in late stage disease. Of those women who visited their GP prior to diagnosis, 90 per cent experienced recognised symptoms and this included 86 per cent of those diagnosed with early stage disease (Stage I or II).

Table 3 includes both the most recent results, and the findings from previous Pathfinders. It shows that GPs’ understanding of ovarian cancer is increasing, but that much remains to be done.

Pathfinder

GPs saying symptoms only present in the later stages of the disease (per cent)

GPs saying ovarian cancer is a silent killer (per cent)

2009

79

96

2012

67

91

2016

44

77

Going to the GP

Among those women who experienced symptoms, 36 per cent went to see their GP within a month of these starting, unchanged from the previous Pathfinder and down slightly on Pathfinder 2009.

60 per cent of women said that they felt their GP took their concerns seriously. Many women faced multiple visits to their GP before being referred for the tests that led to their diagnosis, although as Table 4 shows, this number is gradually falling.

Table 4 – Women visiting their GP three times or more before being referred for diagnostic tests

Pathfinder

Women visiting their GP three times or more before being referred for diagnostic tests (per cent)

2009

54

2012

49

2016

41

The latest findings are broadly comparable to the National Cancer Patient Experience Survey data for 2015, which found 33 per cent of women diagnosed with ovarian cancer reporting visiting their GP three times or more before being referred for diagnostic tests.18 The average across all cancers is 24 per cent of patients having to visit their GP three times or more prior to referral, meaning women with ovarian cancer are more likely to face repeat visits to their GP.19

Misdiagnosis

46 per cent of women were initially referred for tests for something other than ovarian cancer. Guidelines are clear that a possible diagnosis of ovarian cancer should be considered for any woman aged 50 or over presenting with symptoms that suggest irritable bowel syndrome (IBS).20 Of those women responding to Pathfinder 2016 aged 50 or over who visited their GP to discuss symptoms, 21 per cent were told they might have IBS.

In eight per cent of cases among women visiting their doctor with symptoms, GPs suggested their symptoms might be down to mental ill health.

Diagnostic tests

Cancer strategies in all four nations place an emphasis on early diagnosis and timely diagnostic testing.21

Of those GPs responding to our survey, 99 per cent reported they had direct access to CA125 blood tests and 97 per cent direct access to non-obstetric ultrasound in cases of suspected ovarian cancer. This is in contrast to 2009, when more than one in ten GPs reported being unable to directly access non-urgent transvaginal ultrasounds (one of two types of ultrasound scans, the other being abdominal, used in the diagnosis of ovarian cancer).

Despite the improvement in access to diagnostic tests, Table 5 shows there is little change in the overall time it is taking for women to receive a diagnosis compared to previous Pathfinders.

 Table 5 – Time taken from first visiting GP to receiving diagnosis

Pathfinder

Less than one month (per cent)

One to three months (per cent)

Over three months (per cent)

2009

23

32

45

2012

21

30

47

2016

27

29

45

Numbers may not total 100 due to a small number of patients unsure of time taken to receive a diagnosis.