A new study of 183 women with ovarian cancer has shown that women want greater awareness of ovarian cancer symptoms among GPs and a more widespread understanding of family history and genetic risk factors of ovarian cancer as this could lead to earlier diagnosis, optimised treatment and greater prevention.
In a recent study conducted by Ovarian Cancer Australia, it was found that:
- 47% of diagnosed women made two or more visits to a GP presenting with symptoms before being referred to a specialist;
- 21% of diagnoses required three or more visits to a GP with concerns over common symptoms before being referred to a specialist;
- 18% of diagnoses were initiated through presentation at emergency rooms with severe symptoms; and
- of those presenting at emergency rooms, almost a third were preceded by three or more visits to the GP with concerns over common symptoms.
With World Ovarian Cancer Day on 8 May 2015, OCA’s Director for Research and Advocacy Dr Katherine Nielsen says the results are an important reminder that women and GPs must learn the signs and symptoms for the best possible chance at an early diagnosis.
“GPs are the first port of call and are therefore crucial to enabling a timely diagnosis to achieve better outcomes for women with ovarian cancer,” Dr Nielsen says.
“If GPs don’t recognise the symptoms of ovarian cancer, diagnoses will continue to be unnecessarily delayed in many cases. GPs who were aware enabled a fast diagnosis and a short time to treatment.
“A number of respondents reported that their symptoms were often not recognised as relating to ovarian cancer.
“One respondent saw her GP four times and his response was to eat more fibre. Other women told of being repeatedly investigated for Irritable Bowel Syndrome.”
Dr Nielsen says that for nearly 80% of women with ovarian cancer, their pathway to diagnosis was initiated as a result of their concerns for symptoms being experienced, demonstrating it is not a “silent disease”.
“Common symptoms of ovarian cancer – increased abdominal size or persistent abdominal bloating, abdominal or pelvic pain, the need to urinate often or urgently, feeling full after eating a small amount, tiredness and a change in bowel habits– were experienced by over 90% of respondents and they felt an average of 3.3 symptoms each before diagnosis.
“These symptoms were experienced across all stages and types of ovarian cancer,” says Dr Nielsen
A number of women expressed a high level of frustration at the long timeframes leading to the diagnosis, despite seeking regular medical advice. In addition to the need for increased levels of symptom awareness, the pathway to diagnosis can also be improved by more GPs knowing the link between family history and breast and ovarian cancer.
According to previous estimates, up to one in five cases of ovarian cancer are inherited. As brought into the spotlight recently by Angelina Jolie, inheriting a faulty BRCA1 or BRCA2 gene significantly increases a woman’s risk of developing ovarian cancer, as well as breast cancer. This study shows that more women should be offered genetic tests for ovarian cancer, sooner.
The number of women with ovarian cancer who were offered genetic testing was 36% less than those who should have been, according to the referral guidelines as set out by the nationally recognised Cancer Institute NSW’s eviQ resource.
GPs could play a greater role in accelerating diagnoses by asking about family history, especially for women presenting with symptoms. It was found that only a quarter of respondents were asked about their family history by a GP before diagnosis.
31% of respondents were at a higher risk than the general population through having a family history, demonstrating the need for greater dialogue within families as well as between patients and doctors about family histories of breast and ovarian cancer, so that more referrals can be made when needed.
Dr Nielsen highlighted a clear need for better education for women and doctors.
“In the absence of an early detection test, we must all know the signs and symptoms of ovarian cancer and our family history.
“If ovarian cancer awareness is commonplace among GPs, more women will be referred to the right specialist earlier, and more women will be offered genetic testing when it is needed.
“Women must also know and recognise the signs and symptoms which will raise their confidence in asking for the appropriate tests for ovarian cancer, rather than have symptoms attributed to other causes.”