title: Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database.
abstract: BACKGROUND
  Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example.
  
  
  METHODS
  From the General Practice Research Database (GPRD), we identified all women aged 40-80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer.
  
  
  RESULTS
  The GPRD rates peaked earlier, at 70-74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age.
  
  
  CONCLUSIONS
  GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people.
authors.affiliation: Division of Public Health and Primary Care, Brighton and Sussex Medical School, Falmer, Brighton, UK. r.tate@bsms.ac.uk
authors.forename: A R
authors.initials: AR
authors.lastname: Tate
authors.forename: A
authors.initials: A
authors.lastname: Nicholson
authors.forename: J A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D057210:Delayed Diagnosis / Q000941:ethics / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D018579:Patient Selection / Q000941:ethics; D010821:Physicians, Family / Q000941:ethics / Q000706:statistics & numerical data; D011364:Professional Practice / Q000941:ethics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries