Benign ovarian cysts in England and Wales and in the United States

Abstract

Objective To compare the rates of hospital admission for management of ovarian cysts in England and Wales and the United States between 1972 and 1974 and 1984 and 1986; and to determine whether these rates are related to rates of early diagnosis of ovarian cancer. Design Analysis of published and unpublished hospital discharge data based on national samples, the Hospital In‐patient Enquiry (HIPE), a 10% hospital discharge sample for England and Wales, and the National Hospital Discharge Survey (NHDs), a 5% sample for the United States. Main outcome measures Age‐specific discharge rates for primary and secondary diagnoses of ovarian cyst or benign ovarian tumour. Results There was an age‐adjusted increase in discharge rates of about 8% in both countries; discharge rates in the United States were approximately double those in England and Wales in both time periods. There was no difference in the rates of early diagnosis of ovarian cancer. Conclusions Ovarian cysts are a common cause of hospital admission in both countries. The higher rates in the United States are not associated with earlier diagnosis of ovarian cancer.

Management of the Adnexal Mass

“…10,66 -68 Whereas borderline epithelial cancer likely represents a precursor to type I epithelial carcinoma, such studies have not convincingly identified that benign epithelial ovarian cysts increase risk for ovarian malignancy. 9,10,66 -68 Further lending support to this theory are cohort and large prospective observational studies that indicate the removal of persistent simple ovarian cysts is not associated with a decrease in the proportion of expected deaths from ovarian cancer relative to other cancers, 69 and that monitoring of patients with unilocular ovarian cysts smaller than 10 cm without intervention is not associated with evidence of malignant transformation over the course of prolonged observation. [61][62][63][64][65] Thus, the present literature indicates that it may not always be necessary to surgically remove asymptomatic unilocular ovarian cysts thought to represent benign entities.…”

Identification of the optimal pathway to reach an accurate diagnosis in the absence of an early detection strategy for ovarian cancer

“…This sample size (approximating the number of patients who enter such a pathway each year in the U.S.) was determined based on the number of annual ovarian cancer diagnoses in the U.S. plus an estimated rate of approximately 70% negative findings at the time of surgery for a suspected ovarian cancer [2,17]. The simulation was used to quantify the distribution of outcomes to identify the optimal pathway to diagnosis by time and number of health care events.…”

“…Due to the lack of screening or early detection strategies, it is estimated that 60,000 additional women each year are referred to gynecologic oncology for suspected ovarian cancer, representing further surgical and diagnostic procedures [2]. For those later diagnosed with ovarian cancer, the majority will have advanced disease.…”

Dermoid Cyst: A Multicentric Analysis

“…One study, undertaken in the United States, estimated this as 500 admissions per 100,000 women. [2][3][4] Most clinicians who are faced with an ovarian tumor would recommend surgery or expectant management, depending on the clinical complaints and the presumed nature of the lesion. 5 In the case of suspected malignancy, surgery is mandatory, whereas tumors presumed to be benign can be managed by either a minimally invasive surgery 6 or expectant management if the patient is asymptomatic.…”