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Fam Pract. 2019 May 2. pii: cmz013. doi: 10.1093/fampra/cmz013. [Epub ahead of print]

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

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Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus C, Denmark.
Department of Public Health, Aarhus University, Aarhus C, Denmark.
Department of Gynaecology, Odense University Hospital, Odense, Denmark.



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.


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


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


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).


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.


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


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