Background

In their article, Low et al.1 have demonstrated a poor awareness of ovarian cancer symptoms among their study population of 1000 UK women. They go on to describe factors associated with delay in help-seeking behaviour of women with symptoms that could be associated with ovarian cancer. These include being too busy to seek help, difficulty making an appointment to see a general practitioner (GP) and a feeling that they may be wasting the GP's time. The challenge for both women and GPs is that the symptoms of early ovarian cancer are either non-existent or non-specific at best and can often mimic the symptoms of many other benign diseases. In day-to-day clinical practice, GPs are faced with multiple non-specific symptoms that can be present in many cancers. A recent analysis of over 23 000 cancers in women has led to the development of an algorithm that can indicate the probability of different types of cancer being present to help focus further investigation.2 The use of risk assessment tools in general practice is associated with increased investigation, referral and cancer diagnoses.3 Currently, most urgent ‘2-week wait’ referral guidelines are symptom-based and target red flag symptoms which are related to late-stage diagnosis.4 ,5 Ovarian cancer is associated with a 5-year survival rate of approximately 35%. The National Institute for Health and Clinical Excellence (NICE) Clinical Guideline CG1226 addresses some of the main problems that are considered to be responsible for the delays that occur in the ovarian cancer pathway, namely detection and diagnosis. Only a minority (17%) of ovarian cancers are picked up by GP investigation, with most being diagnosed through routine outpatient referral.7

Summary of NICE CG122

The key priorities for implementation are largely focused upon GPs. For general practice this can be summarised as follows:

• Investigation of serum …