Healthcare use and clinical investigations before a diagnosis of ovarian cancer: a register-based study in Denmark

Sep 24, 2026

Ovarian cancer has a poor prognosis, making earlier diagnosis crucial. This nationwide Danish register-based observational cohort study compared health care use in primary care and hospitals between women diagnosed with first-time ovarian cancer or borderline ovarian tumors and non-cancerous controls. Using negative binomial regression and binary regression, the study quantified monthly incidence rate ratios and the likelihood of multiple general practice contacts. Findings show higher primary care contact rates from five months and greater specialized assessment from six to eight months before diagnosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Abstract

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Methods

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Trial registration

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Background

Methods

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Study design

Rousing et al. BMC Primary Care (2023) 24:169 [https://doi.org/10.1186/s12875-023-02132-3](https://doi.org/10.1186/s12875-023-02132-3) BMC Primary Care RESEARCH Open Access Healthcare use and clinical investigations before a diagnosis of ovarian cancer: a register-based study in Denmark Isabella Gringer Rousing 1,2*, Peter Vedsted 1,3, Peter Hjertholm 1, Per Kallestrup 1,2, Marie-Louise Ladegaard Baun 1 and Line Flytkjaer Virgil sen 1 Abstract Background Ovarian cancer (OC) is associated with a poor prognosis, which calls for earlier diagnosis. This study aimed to analyse the health care use in primary care and at hospitals among women with OC compared to noncancerous women to identify a window of opportunity for earlier diagnosis. Methods This nationwide register-based observational cohort study included all Danish women aged ≥ 40 years who were diagnosed with a first-time OC or borderline ovarian tumour in 2012–2018 and with no previous cancer diagnosis (n = 4,255) . For each case, ten non-cancerous women were identified (n = 42,550) . We estimated monthly incidence rate ratios using a negative binomial regression model to assess the use of health care services. We calculated risk ratios of having multiple contacts to general practice before a diagnosis using a binary regression model. Results Cases had statistically significantly higher contact rates to general practice from five months prior to the diagnosis compared to references. From six to eight months prior to diagnosis, an increased use of transvaginal ultrasound and gynaecologist was seen for cases compared to references. Conclusions Increased healthcare use was seen relatively closely to the time of diagnosis for women with OC. This indicates a narrow window of opportunity for a timelier diagnosis. Still, the use of specialised assessment increased at six to eight months before the diagnosis. When women present unspecific symptoms, awareness of potential ovarian malignancies and safety-netting by the general practitioner may be pivotal. Trial registration Not relevant. Keywords General practice, Diagnosis, Ovarian neoplasms, Universal health care, Registries, Denmark *Correspondence: Isabella Gringer Rousing [igrousing@gmail.com](igrousing@gmail.com) 1Research Unit for General Practice, Bartholins Allé 2, Aarhus 8000, Denmark 2Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark 3University Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Falkevej 3, Silkeborg 8600, Denmark © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Rousing et al. BMC Primary Care (2023) 24:169 Background Ovarian cancer (OC) has an age-standardised annual incidence rate of 16.1 per 100,000 women in Denmark [1]. Women with OC (includi

FAQs

What was the study’s primary goal for women with ovarian cancer?

To analyze health care use in primary care and hospitals among women with ovarian cancer compared with non-cancerous women, with the aim of identifying a window for earlier diagnosis.

How were cases and controls selected in the nationwide study?

All Danish women aged 40+ diagnosed with first-time ovarian cancer or borderline ovarian tumor between 2012–2018 and without previous cancer were included (n=4,255), and each case was matched with ten non-cancerous women (n=42,550).

What changes in health care use were observed before diagnosis?

Contact rates to general practice were higher starting about five months before diagnosis. From six to eight months before diagnosis, increased use of transvaginal ultrasound and visits to a gynaecologist were observed.

Sep 24, 2026

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