Patterns In The Diagnosis Of Ovarian Cancer

Delays in the diagnosis of ovarian cancer have been attributed to the absence of ovarian cancer symptoms or vague symptoms at an early stage, delays in careseeking among symptomatic women, and physician delays in considering ovarian cancer in the differential diagnosis. Early-stage symptoms may be subtle, seemingly unrelated, and not necessarily gynecological in nature, and a woman may undergo a number of medical tests before ovarian cancer is considered a possible diagnosis. The most common diagnostic pathways from first provider visit to diagnosis of ovarian cancer are not known and are likely to vary by age and risk factors related to the patient, the symptoms reported, the specialty of the physician initially consulted, and myriad other patient, provider, and healthcare setting characteristics. In addition, a substantial proportion of ovarian masses detected during diagnostic workup are benign. Aggressive follow-up of ovarian abnormalities to detect cancer must be balanced with appropriate assessment to reduce the number of women who undergo unnecessary diagnostic surgery. If surgery identifies ovarian cancer, the specialty of the attending surgeon can affect the quality of staging and tumor debulking procedures conducted and, ultimately, the disease-free survival time. To discover if such interventions as physician guidelines, educational materials, or other actions can significantly reduce the time to diagnosis, detect the cancer at earlier stages, or improve surgical evaluation, a great deal more information is needed about the symptoms reported and the current diagnostic process. A specific component in the diagnostic pathway is the management of ovarian masses, and DCPC is currently conducting a study, Clinical Practice in the Follow-Up of Ovarian Masses. This study will search for clinical findings that could be used by clinicians to more effectively differentiate between women with potentially malignant masses who require immediate surgery and women with benign abnormalities. Set in a managed care organization, the goals of the study are to investigate the symptoms or other conditions that lead to a diagnosis of an ovarian mass, the radiological characteristics of masses most likely to be malignant, and the diagnostic pathways commonly followed. Medical records, imaging studies, and surgical reports will be abstracted for a cohort of women aged 40 and older who have an ultrasound-identified ovarian mass. Data will be collected on mass characteristics, medical and family history, symptoms, findings, diagnoses, and related diagnostic tests and treatment. Researchers will assess the prevalence, characteristics, symptoms, and diagnostic management of benign vs. malignant ovarian masses.