Diagnosis of ovarian cancer in primary careBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3286 (Published 26 August 2009) Cite this as: BMJ 2009;339:b3286
All rapid responses
I started reading the Diagnosis of Ovarian Cancer in Primary Care
Editorial (September BMJ) with excitement and hope that I would be able to
improve my identification of this difficult cancer.
We have recently audited new cancer diagnoses in our practice over
the last year (1 April 2008 – 31 March 2009). During this period 57 new
cancers were diagnosed from a population base of 16,400. 3 of these new
cancers were ovarian, all of which were diagnosed through a change in
bowel habit and were initially referred on a 2 week wait to our local
colorectal surgeons. The editorial describes the 7 symptoms which are
associated with ovarian cancer. The most discerning of these is abdominal
distention with a positive predicative value of 2.5%, but I do not think
it is a symptom that provides me with a useful predictor of ovarian
cancer. Abdominal bloating is an extraordinarily common symptom in
primary care and I cannot agree with the author's conclusion that it
warrants urgent referral. Our cancer care service would be overwhelmed
with patients who have IBS.
I can only conclude that we must remain vigilant and anticipate that
we will usually diagnosis ovarian cancer through a different referral
pathway than directly to the gynaecologists.
1. Austoker, J. Diagnosis of ovarian cancer in primary care. BMJ
2009; 339; 5832584
Competing interests: No competing interests