Why Ovarian Cancer Is Detected Late: Insights from Patient Records Focus on Pakistan

Abstract

Ovarian cancer (OC) is one of the most lethal gynecologic cancers in the world, especially because of the late diagnosis. This systematic review and meta-analysis are a mixed method study that explores the causes of diagnostic delays in Pakistan and other Low- and Middle-Income Countries (LMICs), based on published literature and medical histories of patients. PRISMA 2020 guidelines were used to analyze eighteen studies published in the year 2019 to 2025. The review identified a mean diagnostic time of 150.2 days, which was mainly as a result of an extended patient interval (105.1 days in Pakistan) and diagnostic interval (61.5 days). The quantitative results indicate that late care-seeking is closely linked with an advanced stage of presentation (FIGO III–IV; OR = 2.8), non-specialist or traditional healer initial consultations, financial limitations, geographic factors, and poor health literacy. Among primary-care providers, cultural normalization of symptoms, stigma, financial toxicity, low levels of clinical suspicion, and low levels of diagnostic facilities were found to be the most prevalent contributors to qualitative synthesis. Triangulation revealed the process of a combination of cultural, social, and health-system barriers to prolong the diagnostic pathway. The results highlight the importance of culturally sensitive awareness, better primary care training, and affordable diagnostic access to decrease the delays and enhance the OC outcomes.