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Effects of possible inaccuracies in dating of diagnosis on the frequencies and timing of the most commonly reported symptoms were investigated using four increasingly inclusive definitions of first diagnosis/suspicion: 1. The most commonly coded symptoms before a definite diagnosis of ovarian cancer, were abdominal pain (41%), urogenital problems(25%), abdominal distension (24%), constipation/change in bowel habits (23%) with 70% of cases reporting at least one of these.

The median time between first reporting each of these symptoms and diagnosis was 13, 21, 9.5 and 8.5 weeks respectively.

Symptoms recorded in the General Practice Research Database are similar to those reported in the literature, although their frequency is lower than in studies based on self-report.

Diagnostic codes start with a letter whereas symptoms, signs, investigations, procedures and administration tasks start with a number. If another type/site of cancer has been diagnosed any time during the 4 years prior to the eventdate associated with a generic cancer code (e.g.The reasons for this are not fully understood but may be due partly to delays in diagnosis and/or treatment after first onset of related symptoms, either because patients do not report their symptoms (patient delay), or because GP do not refer them quickly when they do (primary care delay).It is clear that a more thorough understanding of the extent and determinants of delay will be needed if cancer survival rates in the UK are to be improved [].It contains anonymised longitudinal data on a representative sample of about 6% of the UK population – 3 million currently registered patients and over 8 million historic patients.The GPRD collects data from about 450 general practices throughout the UK and is widely used in research on disease epidemiology, drug safety and adverse drug reactions.Studies of cancer incidence and early management will increasingly draw on routine electronic patient records. We developed a generalisable strategy for investigating presenting symptoms and delays in diagnosis using ovarian cancer as an example.The General Practice Research Database was used to investigate the time between first report of symptom and diagnosis of 344 women diagnosed with ovarian cancer between 01/06/2002 and 31/05/2008. "First treatment or complication suggesting pre-existing diagnosis", 4 "First relevant test or referral".Read codes: B440.00 (Malignant neoplasm of ovary) B440.11 (Cancer of ovary) or B44..00 (Malignant neoplasm of ovary and other uterine adnexa) or OXMIS codes: 1830A (Malignant neoplasm ovary), 1830AD (adenocarcinoma ovary), 1830C (Carcinoma ovary), 1830MC (mucinous cystadenocarcinoma ovary). Cancer treatment or referral code All codes indicating a prior cancer diagnosis e.g "cancer care review", "chemotherapy", referral to oncologist. Investigation or referral code for suspected ovarian cancer This category included codes for a relevant investigation (e.g ultrasound scan, CA125 test), diagnostic procedure (e.g. This definition was included in order to identify when the GP was first recorded as taking action to investigate the ovarian cancer.Read codes (which have superseded the OXMIS codes) were specifically developed for use in UK primary care by Dr James Read during the 1980s are used to record all medical events in clinical practice. Four index dates based on these categories were constructed for each case, in order of increasing inclusivity, beyond the first Read code indicating a definite diagnosis of ovarian cancer.Electronic patient recording in general practice allows flexible recording to take place and subsequently the completeness and accuracy of coded data is often variable [].In some instances, information may be stored only implicitly and it is not uncommon to find the actual diagnosis of a condition recorded at a late stage in the disease. In order to pick up any codes for relevant symptoms, investigations or referrals which may have been missed, we examined the anonymised records of individual patients in the six-month period before definite diagnosis date, and also tabulated the most commonly occurring Read codes in order of frequency.19% had a code for definitions 2 or 3 prior to definite diagnosis and 73% a code for 4.However, the proportion with symptoms and the delays were similar for all four definitions except 4, where the median delay was 8, 8, 3, 10 and 0 weeks respectively.Women with a previous definite or closely related diagnosis of ovarian cancer (Table ) were excluded from the cohort. The incidence of major categories of commonly reported symptoms was estimated for each time period by dividing the number of patients reporting each symptom at least once in the given time period by the number of patients.A medical diagnosis of ovarian cancer was defined by a Read or OXMIS code for this condition recorded in the patient's clinical or referral record i.e. Software: Data management was undertaken using My Sql In order to determine the possible effects of inaccurate dating on the estimates of percentage of symptoms and delays, a sensitivity analysis was carried out using 4 alternative categories of Read codes indicating a diagnosis of, or investigation for ovarian cancer. Definite diagnostic code only Read codes for a case of ovarian cancer or malignant primary ovarian neoplasm as defined above ("definite diagnosis" in Table ). More general "ambiguous" code which could indicate diagnosis of ovarian cancer This category included ambiguous but very closely related Read code indicating possible ovarian cancer ("very closely related diagnosis" in Table ) together with at least one more general codes such as "Cancer", "Secondary neoplasm of other specified sites" and "Carcinomatosis" Category 3.

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