The Importance of Early Diagnosis

Late ovarian cancer diagnosis after emergency admission is common, especially among frail and vulnerable women.

A new study has found that two in five women with ovarian cancer are diagnosed only after being admitted to hospital as an emergency, leaving them three times less likely to have early-stage disease, when treatment is most effective and the chances of a cure are highest. ()

The findings, published in the open-access journal BMJ Oncology, highlight significant gaps in the early detection of ovarian cancer and identify women who are young, elderly, frail, or living in deprived areas as being at the greatest risk of receiving a delayed diagnosis.

Researchers say the findings underscore the urgent need to improve awareness of ovarian cancer symptoms and strengthen referral and diagnostic pathways so that more women are diagnosed before the disease reaches an advanced stage.

More Than 40% Diagnosed After Emergency Hospital Admission

For the study, researchers analyzed national cancer registry data from 28,204 women diagnosed with ovarian cancer in England between January 2017 and December 2021. The data were linked with hospital admission records to determine how women were diagnosed.

The analysis showed that 11,377 women—just over 40% of all cases—received their ovarian cancer diagnosis within 28 days of an emergency hospital admission.

Women diagnosed in this way were three times less likely to have early-stage ovarian cancer, highlighting how delayed diagnosis can reduce treatment options and worsen outcomes.

Why Ovarian Cancer Is Difficult to Detect

Ovarian cancer is the eighth most common cancer among women worldwide, causing more than 200,000 deaths every year.

Unlike some cancers that produce obvious warning signs, ovarian cancer often develops with vague symptoms such as persistent bloating, abdominal or pelvic pain, feeling full quickly, changes in bowel habits, or frequent urination. These symptoms are commonly mistaken for digestive or other non-cancerous conditions, making the disease particularly difficult to diagnose early.

To better understand why so many women are diagnosed only after an emergency admission, researchers examined the factors associated with delayed diagnosis.

Key Factors Linked to Emergency Ovarian Cancer Diagnosis

The study identified frailty, age, and socioeconomic deprivation as the strongest factors associated with an emergency diagnosis.

Frailty emerged as the biggest risk factor. Among 3,372 women classified as severely frail, nearly 69% were diagnosed only after an emergency hospital admission. By comparison, just 29% of the 9,912 women who were considered physically fit received their diagnosis following an emergency admission. The researchers suggest that frailty may make symptoms harder to recognize or delay referral for specialist investigations.

Age also played a significant role. Women aged 18 to 29 years were 36% more likely to receive an ovarian cancer diagnosis after an emergency admission than women in their 60s. Overall, 43% of women in this younger age group were diagnosed following emergency hospitalization.

Researchers believe one possible explanation is that ovarian cancer is not commonly considered a disease affecting younger women, meaning symptoms may be overlooked or attributed to less serious conditions. Older women were also particularly vulnerable. Among women aged 80 years and above, 55% were diagnosed after an emergency admission—25% more likely than women in their 60s.

The study also found clear socioeconomic inequalities. Women living in the most deprived neighborhoods were 11% more likely to receive their ovarian cancer diagnosis after an emergency admission than women living in the least deprived areas, even after accounting for differences in age and frailty.

The findings suggest that social and healthcare inequalities may influence how quickly women are assessed and diagnosed.

Late Diagnosis Often Means Advanced Disease

The analysis found that women diagnosed after an emergency admission were much more likely to have advanced ovarian cancer. Among the 8,438 women for whom cancer stage information was available, only 14% of those diagnosed after an emergency admission had early-stage (Stage 1 or Stage 2) disease.

In comparison, more than 39% of women diagnosed through non-emergency routes had early-stage cancer. Researchers also found that women diagnosed following an emergency admission were three times less likely to have slow-growing tumors, which are generally easier to treat and associated with better outcomes.

Researchers Call for Earlier Ovarian Cancer Diagnosis

The researchers noted that the higher rate of emergency diagnoses among younger women was unexpected because they generally have higher rates of early-stage, low-grade ovarian cancers.

“The risk of being diagnosed with ovarian cancer after an emergency admission was higher in younger women, despite having higher rates of early stage low grade cancers—factors associated with lower rates of ovarian cancer diagnosis following emergency admission,” the researchers wrote, suggesting this may be because ovarian cancer is rarely considered a disease affecting younger women.

They added that delayed diagnosis is likely influenced by a combination of patient-related factors and healthcare system challenges that require further investigation.

A Global Challenge, Not Just an England Problem

Although the study focused on women in England, the researchers said the issue extends well beyond one country. “The issue of ovarian cancer diagnosis following an emergency admission is not confined to England but also affects countries such as the U.S., Australia, Denmark, Norway, Canada and New Zealand, where the rates range from about 20% to 50%,” they noted.

The researchers called for coordinated efforts to improve referral systems, reduce diagnostic delays, and increase awareness of ovarian cancer symptoms among both the public and healthcare professionals.

“Concerted action, where possible with support from international collaborations, is needed to improve referral and diagnostic pathways, with a focus on increasing patient awareness, improving early recognition of alarm symptoms, handling the prioritization of waiting lists, and developing efficient diagnostic pathways that can provide a timely service to the many women with non-specific symptoms,” they concluded.

Study Strengthens the Case for Earlier Diagnosis

The researchers acknowledged that the study was observational, meaning it cannot establish a direct cause-and-effect relationship between emergency admission and cancer outcomes.

The analysis also lacked complete information on certain factors, including coexisting medical conditions, cancer stage and grade for some patients, and women’s interactions with primary care services before hospital admission.

Even so, the findings provide one of the clearest national pictures to date of how women are diagnosed with ovarian cancer and highlight opportunities to improve earlier detection.

References:

1. Ovarian cancer diagnosis within 28 days after an emergency admission to hospital: national population-based study of patient risk factors and cancer characteristics using routinely collected data in England – (https://bmjoncology.bmj.com/content/5/2/e001053)

Source-Medindia