Introduction Timely referral to a gynecologic-oncologist (GO) in the management of an ovarian mass could make a significant difference in the prognosis and survival of patients. Understanding the factors affecting referral decisions in a teaching institution will improve strategies for supervision of trainees as well as overall patient outcomes.

Methods This is an ongoing randomized controlled trial using OVERA among Filipino women with ovarian masses in a university hospital. OVERA results were made available pre-operatively to high risk (M) and low risk - disclosure (BD) groups, but not to the low risk - Non-Disclosure (BND) group. The impact of clinical and biochemical factors on the decision for GO referral was evaluated through a questionnaire.

Results There were 347 women included in this analysis. Only 30.84% (n: 107, CI: 26.01–35.99%) were referred to a GO prior to surgery. More than half of the women assigned in the M group (79, 54.48+) were referred in contrast to BD (17, 17+) and BND (11, 10.78+) groups (χ2: 66.22, p<0.01). Only three women (0.87+, CI: 0.18–2.53%) had post-operative complications, less than a tenth (n: 13/335, CI: 2.08–6.54%) had a gynecologic-oncologist as the primary surgeon, and more than a quarter (n: 77/252, CI: 24.93–36.65%) of patients needed intra-operative referral to a specialist. Among all the factors investigated, only HE-4 levels (&zstrok;: 2.45, p: 0.01) influenced non-referral to an oncologist.

Conclusion Subspecialty referral is underutilized even in the presence of key determinants of increased malignancy risk. Recognition of available assessment factors will help optimize patient care.