Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care
Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care
复制标题
英国卵巢癌的诊断途径：初级保健队列研究
DOI：
10.1111/j.1471-0528.2010.02587.x
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
M. Cruickshank
中科院分区：
文献类型：
--
作者：
D. Parkin;M. Cruickshank
Sir, We read with interest the recent publication from Barrett et al. on the pathways to the diagnosis of ovarian cancer. It cannot however claim to be the first to map out the route to diagnosis of ovarian cancer. The results closely mirror those that we found in a population-based study of the effect of the introduction of a gynaecological cancer fast track clinic on the referral pathway and referral to diagnosis time in women with ovarian cancer, which was published in 2003. This paper examined 242 women diagnosed in the Grampian Region from 1995 to 2001 (3 years before and after the introduction of the fast track clinic). We were unable to access general practitioner (GP) records, but from the referral letters we ascertained that over 73% complained of distension, bloating, a mass, pain or gastrointestinal symptoms. Serum CA125 had been measured in 6% before or at the time of referral by the GP. We found a disappointingly low number of women referred to the fast track clinic (13%). Of the others, 36% were admitted as an emergency, predominantly to general surgery or medicine; 28% were referred to a general gynaecology clinic; and 29% were referred to a medical or surgical outpatient clinic. Unfortunately, the introduction of the fast track clinic had little impact on referral patterns, emergency admissions actually rose following its establishment. There was a reduction in median referral to diagnosis time from 23 to 17 days but this was not significant after linear regression analysis of other variables was considered. Referral to another specialty and performance status had a significant impact on the time to diagnosis. It is of concern that the study by Barrett et al. did not show any real improvement in referral pathways for women with ovarian cancer over recent years despite the availability of GP-organised ultrasound scanning. Although it is true that most women with ovarian cancer have symptoms for some time before diagnosis, a recent large case–control study has shown a positive predictive value for ovarian cancer of under 1% in women with those symptoms. This may account for the fact that ovarian cancer is not the diagnosis that a GP is most likely to reach rapidly in women with this symptomatology. j
