Thousands of older women receive ‘shockingly inadequate’ ovarian cancer care when compared with younger women, meaning they are far less likely to survive the disease, experts have warned.
The over-70s face an average delay of five months before being referred to specialists, according to data collected by Ovarian Cancer Action – twice as long as the wait faced by younger women.
Also, many older ovarian cancer patients are not offered curative surgery to remove their tumours, and one in five receive no treatment at all.
According to the charity, the figures explain the disproportionately high mortality rate for women over 70 with ovarian cancer – nearly half die within a year of diagnosis, compared with the average figure of just under a third.
Experts blame the inequality of treatment on age discrimination, claiming that as patients get older, symptoms are taken less seriously.
Missed: Anna Perkins with her aunt, Mary Barrett, who died aged 71. Anna believes her aunt’s age was a factor in her slow diagnosis
Women who take the Pill are at lower risk of ovarian cancer, as are women who have children. The more children, the lower the risk.
Marie-Claire Platt, head of research at Ovarian Cancer Action, says: ‘Older patients with ovarian cancer are being let down at every stage. There’s a myth that ovarian cancer is a silent killer – it’s not, it’s a manageable cancer when caught early. But for many older women, that’s not happening.’
More than 7,000 women in the UK are diagnosed with ovarian cancer every year, with 4,000 killed by the disease. Of those, more than a third are aged 60 and over.
As with most cancers, ovarian cancer becomes more common as you get older. The risk increases steeply from around 45 and is greatest in those aged between 75 and 79. Between five and 15 per cent of cases are known to be linked to inherited genes.
While symptoms can vary, the first signs of the disease are often abdominal pain, bloating and needing to go to the toilet more than usual. If diagnosed and treated early, it can be managed with a range of treatments including surgery and chemotherapy.
And if spotted at its earliest stage, nine in ten women will survive for at least five years. But when diagnosed late, the figure drops to just one in ten.
‘As we get older, we develop more ailments, so GPs might struggle to spot cancer straight away,’ says Platt. ‘But instead of assuming it’s simply age-related aches and pains, doctors should first refer women for tests – just in case.
‘Another problem is that doctors often wrongly assume older women are not fit enough to undergo surgery. But fitness isn’t defined by age, every woman is different. Women should at the very least be presented with the option of surgery so they can decide for themselves.’
Experts say older women’s symptoms are too often mistaken for common bowel problems.
‘Women in their 60s and 70s with ovarian cancer symptoms are told they have IBS,’ says Hilary Maxwell, a senior gynaecology nurse and chief executive of cancer support group GO Girls. ‘This seems confusing, given that studies show IBS usually appears before the age of 50.’
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A lack of awareness of red flags among older women is also said to contribute to late diagnosis.
‘This is a generation of women who are not used to talking openly about gynaecological issues,’ says Maxwell. ‘And when patients see their GP, they may talk around the subject because they are embarrassed. So it is important to educate and tell women to be more assured and push GPs to look for cancer.’
Mary Barrett, a former bank clerk from Liverpool, was 68 when she was diagnosed with ovarian cancer in 2015 – but doctors later found it most likely developed three years before her diagnosis.
Sadly, the cancer was spotted at such a late stage that she lived for just three more years, and died in 2017, aged 71. Her niece Anna Perkins, 31, an education executive from Manchester says: ‘For a number of years Mary was feeling constantly bloated and her bowel habits changed. She went to her GP but at first he thought it might be IBS or a bladder infection.
‘Mary went back and forth to her doctor for years. At one point she was even sent to hospital to see if she had bowel cancer, but when there was no evidence of that they finally investigated ovarian cancer. By the time they found the cancer it was too late.
‘They gave her chemotherapy and had planned to operate, but eventually there was no point – the cancer had spread and was inoperable.’
The over-70s face an average delay of five months before being referred to specialists, according to data collected by Ovarian Cancer Action (file photo)
She believes her aunt’s age was a factor in her slow diagnosis, adding: ‘There is a sense that aches and pains are just part of getting old and they’re not properly examined to find a cause.
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Being a GP is an incredibly difficult job and they can’t spot everything, but if my aunt’s symptoms were more closely investigated it’s possible she might still be alive today.’
Platt says the report by Ovarian Cancer Action provides proof of what she calls ‘healthcare inequality’: ‘A woman with ovarian cancer deserves the best chance to survive her disease, no matter what her age. But for many older women, this is not being reflected in their care.’
Julie Drake, 62, a former shop owner, was diagnosed with stage-three ovarian cancer in June last year, but was forced to lie to get access to a life-saving scan.
She began feeling bloated in early June and her stomach began to swell. At first she thought it was constipation. ‘It felt like I was incredibly full and I had painful haemorrhoids too,’ says Julie, from Bournemouth. ‘When the symptoms didn’t go away after a week, I called my GP.
‘It was during lockdown so I wasn’t able to get an appointment in person.
‘He diagnosed me over the phone with constipation and offered to prescribe me steroid cream for the haemorrhoids. I refused and said the cream wasn’t going to help the swelling.’
Her GP agreed to arrange a scan at the local hospital, but two weeks later Julie still hadn’t received an appointment date.
She says: ‘My symptoms were getting worse and worse, my stomach was beginning to look like a barrel and I was in a lot of pain.’
Eventually she felt forced to pretend she’d been vomiting, in order to be fast-tracked for an emergency scan. The results showed advanced ovarian cancer. She needed immediate surgery to remove the tumour and her ovaries, followed by chemotherapy then radiotherapy.
In December, Julie was given the all clear. ‘If I hadn’t lied about my symptoms in order to get a scan, I’m not sure I’d be here,’ she says.