Article Text

Download PDFPDF
Examining the Effects of Time to Diagnosis, Income, Symptoms, and Incidental Detection on Overall Survival in Epithelial Ovarian Cancer: Manitoba Ovarian Cancer Outcomes (MOCO) Study Group
  1. Alon D. Altman, MD, FRCSC*,,
  2. Pascal Lambert, MSc,
  3. Allison J. Love, BSc§,
  4. Donna Turner, PhD,
  5. Robert Lotocki, MD, FRCSC*,,
  6. Erin Dean, MD, FRCSC*,,
  7. Shaundra Popowich, MD, FRCSC*, and
  8. Mark W. Nachtigal, PhD*,,
  1. *Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba;
  2. Department of Epidemiology and
  3. Division of Gynecologic Oncology, CancerCare Manitoba;
  4. §Faculty of Health Sciences and
  5. Department of Biochemistry and Medical Genetics, University of Manitoba; and
  6. Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
  1. Address correspondence and reprint requests to Alon D. Altman, MD, FRCSC, RS 406, 810 Sherbrook St, Winnipeg, Manitoba, Canada R3A 1R9. E-mail:


Objective The primary objectives of this study were to analyze data on time to diagnosis and correlate this with overall survival. We secondarily analyzed the effects of emergency room visits, symptoms, incidental findings, residence, socioeconomic status, and residual disease on overall survival.

Methods This retrospective population-based descriptive cohort study examined all invasive ovarian cancer cases in Manitoba, Canada, between 2004 and 2010. Clinicopathologic, socioeconomic, and outcome data were collected. Analysis was performed with Cox and logistic regression stratified by early and late stage.

Results Six hundred eighty-seven ovarian cancer patients were identified, with a final cohort of 601 patients: 210 with early-stage (1/2) and 391 with late-stage (3/4) disease. No presenting symptoms were associated with survival outcome. Poorer survival was associated with increasing age (P = 0.0016) and neoadjuvant chemotherapy (P = 0.0037). Higher income within the urban setting was also associated with a survival advantage (P = 0.0037), whereas initial presentation to the emergency room (P = 0.0399) was associated with decreased survival. Finally, for advanced-stage disease, incidental diagnosis had a significantly improved overall survival (hazard ratio, 0.424; 95% confidence interval, 0.27–0.67; P = 0.0003), even when accounting for confounding factors. Time from first presentation to diagnosis was associated with survival (P = 0.0309).

Conclusions This study found that time to diagnosis did not negatively impact overall survival, although there was an association. Age, morphology, treatment type, residual disease, medical comorbidities, and income were significant prognostic factors. This is the first study to show a survival advantage to incidentally finding an ovarian cancer. Further research is needed on the outcomes of pelvic examination.

  • Incidental finding
  • Ovarian cancer
  • Overall survival
  • Time to diagnosis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • This study was made possible by a CancerCare Manitoba Foundation operating grant.

  • This study’s abstract has been submitted to the International Gynecologic Cancer Society for its 2016 annual general meeting.

  • The results and conclusions are those of the authors, and no official endorsement by Manitoba Health, Healthy Living and Seniors is intended or should be inferred.

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (