Ovarian cancer suspicion, urgent referral and time to diagnosis in Danish general practice: a population-based study

Fam Pract. 2019 Nov 18;36(6):751-757. doi: 10.1093/fampra/cmz013.


Background: Ovarian cancer (OC) survival rates are lower in Denmark than in countries with similar health care. Prolonged time to diagnosis could be a contributing factor. The Danish cancer patient pathway (CPP) for OC was introduced in 2009. It provides GPs with fast access to diagnostic work-up.

Objective: To investigate cancer suspicion and pathway use among GPs and to explore the association between these factors and the diagnostic intervals (DIs).

Methods: We conducted a national population-based cohort study using questionnaires and national registers.

Results: Of the 313 women with participating GPs, 91% presented with symptoms within 1 year of diagnosis, 61% presented vague non-specific symptoms and 62% were diagnosed with late-stage disease. Cancer was suspected in 39%, and 36% were referred to a CPP. Comorbidity [prevalence ratio (PR): 0.53, 95% confidence interval (CI): 0.29-0.98] and no cancer suspicion (PR: 0.35, 95% CI: 0.20-0.60) were associated with no referral to a CPP. The median DI was 36 days. Long DIs were associated with no cancer suspicion (median DI: 59 versus 20 days) and no referral to a CPP (median DI: 42 versus 23 days).

Conclusions: Nine in ten patients attended general practice with symptoms before diagnosis. Two-thirds initially presented with vague non-specific symptoms were less likely to be referred to a CPP and had longer DIs than women suspected of cancer. These findings underline the importance of supplementing the CPP with additional accelerated diagnostic routes.

Keywords: Denmark; general practice; ovarian neoplasms; referral; symptom assessment; time to diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Delayed Diagnosis / statistics & numerical data*
  • Denmark / epidemiology
  • Early Detection of Cancer / standards*
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • General Practice
  • Humans
  • Male
  • Middle Aged
  • Ovarian Neoplasms / diagnosis*
  • Ovarian Neoplasms / epidemiology
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality of Health Care / standards
  • Referral and Consultation / standards
  • Referral and Consultation / statistics & numerical data
  • Registries
  • Surveys and Questionnaires