Data reveal 2 in 5 women with ovarian cancer diagnosed only after emergency admission
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Two in five women with ovarian cancer are diagnosed only after an emergency hospital admission, when they are three times less likely to have early-stage and potentially curable disease, finds a data analysis published in the open-access journal BMJ Oncology.
Rates of diagnosis after an emergency admission are even higher among women who are young, old, frail or who live in deprived areas, the findings indicate.
Ovarian cancer is the eighth most common cancer among women worldwide, taking the lives of more than 200,000 women every year, note the researchers, who add that it's not easy to diagnose because it shares several symptoms with common benign conditions.
In a bid to improve earlier diagnosis, the researchers set out to identify key factors associated with the risk of an ovarian cancer diagnosis within 28 days of an emergency hospital admission.
They drew on national cancer registry data for all 28,204 adult women diagnosed with the disease in England between Jan. 1, 2017, and Dec. 31, 2021, which were then linked to hospital admission records.
Between January 2017 and December 2021, 11,377 women—just over 40% of the total—were diagnosed within 28 days of an emergency hospital admission.
Certain factors were associated with the highest risk: frailty, youth, old age and economic deprivation.
Among the 3,372 women who were very frail, denoted by a SCARF index of "severe frailty," more than two-thirds (2,313; nearly 69%) were diagnosed after an emergency admission. This compares with 2,891 (29%) of the 9,912 women who weren't categorized as frail (SCARF index of "fit").
Diagnosis after an emergency admission was also 36% more likely in 18- to 29-year-olds (209 of 490; 43%), and 25% more likely in older (80+) women (2,952 of 5,379; 55%) than among women in their 60s (2,319 of 6,402; just over 36%).
"The risk of being diagnosed with ovarian cancer after an emergency admission was higher in younger women, despite having higher rates of early stage low grade … cancers—factors associated with lower rates of ovarian cancer diagnosis following emergency admission," highlight the researchers, possibly because ovarian cancer isn't regarded as a young woman's disease, they speculate.
Similarly, women from the most deprived neighborhoods were 11% more likely to be diagnosed after an emergency admission (2,377 of 5,823; just over 44%) than those from the least deprived (2,367 of 6,261; 38%), even after accounting for influential factors such as age and frailty.
Disease diagnosed following an emergency admission was more likely to be advanced, the analysis showed. Among the 8,438 women for whom information on stage was available, just 1,155 (14%) had early-stage (1 or 2) cancers compared with 5,442 (just over 39%) of the 13,865 women who weren't diagnosed after an emergency admission.
Women diagnosed after an emergency admission were also three times less likely to have slow-growing tumors (958 of 2,224; 14.5%) than women who weren't admitted as an emergency (2,892 of 11,946; just over 24%).
This is an observational study, and no firm conclusions can be drawn about cause and effect. Added to which, the researchers acknowledge various limitations to their findings. For example, they didn't have complete information on the presence of coexisting conditions and cancer stage and grade, nor did they have any information on the women's primary care use before admission.
There's likely to be an interplay of various patient and health care service factors behind the findings, all of which merit further investigation before outcomes for women with ovarian cancer can be improved, suggest the researchers.
But this isn't just a problem for England, they highlight. "The issue of ovarian cancer diagnosis following an emergency admission is not confined to England but also affects countries such as the U.S., Australia, Denmark, Norway, Canada and New Zealand, where the rates range from about 20% to 50%," they point out.
"Concerted action, where possible with support from international collaborations, is needed to improve referral and diagnostic pathways, with a focus on increasing patient awareness, improving early recognition of alarm symptoms, handling the prioritization of waiting lists, and developing efficient diagnostic pathways that can provide a timely service to the many women with non-specific symptoms," they conclude.
More information
Ovarian cancer diagnosis within 28 days after an emergency admission to hospital: national population-based study of patient risk factors and cancer characteristics using routinely collected data in England, BMJ Oncology (2026). DOI: 10.1136/bmjonc-2025-001053
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Sadie Harley
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