Worldwide, more than 200 000 new cases of ovarian cancer occur each year, and these account for around 4% of all cancers diagnosed in women.1 Overall the five year survival rate from ovarian cancer is poor at around 30-40%. For women diagnosed with early stage disease, the five year survival rate is over 70%, but only a fifth of cases are diagnosed early.2 For women with late stage disease, the five year survival rate is around 15%. No effective screening test is available.

Earlier identification of symptoms could improve prognosis,3 4 and in the linked case control study (doi:10.1136/bmj.b2998), Hamilton and colleagues report the predictive value of symptoms in diagnosing ovarian cancer in primary care.5

The late stage of presentation has been blamed on the insidious nature of the disease, which has vague non-specific symptoms. Historically, ovarian cancer has been referred to as the “silent killer” because it was believed that no symptoms were evident in early disease. Deciding which patients to refer to a specialist is difficult for primary care doctors because the presenting symptoms of ovarian cancer …