Open Access Highly Accessed Research article

Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample

Kate E Brain1*, Stephanie Smits1, Alice E Simon23, Lindsay J Forbes4, Chris Roberts5, Iain J Robbé6, John Steward7, Ceri White7, Richard D Neal8, Jane Hanson9 and on behalf of the ICBP Module 2 Working Group

Author Affiliations

1 Cochrane Institute of Primary Care and Public Health, Neuadd Meirionydd, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS, UK

2 School of Health Sciences, City University London, London, UK

3 CR-UK Health Behaviour Research Centre, University College London, London, UK

4 Promoting Early Presentation Group, King’s College London, London, UK

5 Knowledge and Analytical Services, Welsh Government, Cardiff, UK

6 Faculty of Medicine, Memorial University, Newfoundland, Canada

7 Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK

8 North Wales Centre for Primary Care Research, Bangor University, Bangor, UK

9 Cancer National Specialist Advisory Group, Cardiff, UK

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BMC Cancer 2014, 14:171  doi:10.1186/1471-2407-14-171

Published: 10 March 2014



While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP).


Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks).


The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 – 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 – 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 – 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 – 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 – 1.07, p = 0.74).


Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised.

Ovarian cancer; Symptoms; Awareness; Anticipated delay