Women with suspected diagnosis of ovarian cancer in Ghana: how much do we know about them?

Background: Addressing disparities in ovarian cancer care between sub-Saharan Africa and other regions begins with the fundamental question, “Who gets ovarian cancer?” This study aimed to identify the demographic and clinical predictors of cancer among women with ovarian tumours. Methods: We conducted a cross-sectional analysis of women with histology-confirmed ovarian tumour discussed at a multidisciplinary tumour board in a tertiary hospital in Ghana between 2013 and 2024. Descriptive statistics were used to summarise the characteristics of the women, and logistic regression was performed to identify predictors of ovarian cancer. P≤0.05 was considered statistically significant. Results: Of the 496 women whose data were analysed, 74.4% (n=369) had ovarian cancer. Women diagnosed with ovarian cancer were older than those without cancer (median age 50 years (36-60) vs 39 years (26-55), p<0.001). Most women (274, 55.3%) were married; 297 (59.9%) were multiparous; 291 (58.7%) were urbanites; and more women with cancer were unemployed (93 vs 8, p=0.023). Most women (281, 56.7%) reported abdominal distension. Women with cancer had anaemia (p<0.001), hypertension, diabetes, or other comorbidities (p=0.012). Of the 127 benign tumours, mature cystic teratomas (50, 39.4%), mucinous tumours (28, 22.0%), serous tumours (20, 15.7%), and ovarian fibromas (12, 12.9%) were common. Few (30, 7.5%) and 3 (0.8%) had immunohistochemical and genetic tests, respectively. Travel distance of 100 km or more, (aOR 2.82; 95% CI: 1.21-6.56) postmenopausal status (aOR 6.43; 95% CI: 1.98-20.92), symptom duration of 3-6 months (aOR 2.85; 95% CI: 1.36-5.95), anaemia (aOR 3.74; 95% CI: 1.93-7.25) and hypertension, diabetes, or other comorbidities (aOR 3.74; 95% CI: 1.93-7.25) were predictors of ovarian cancer. Other predictors were tumours with a solid component (aOR 12.97; 95% CI: 3.16-53.18), vascular flow on imaging (aOR 9.53; 95% CI: 4.63-19.65), ascites (aOR 3.62; 95% CI: 1.84-7.14) and elevated serum CA-125 levels (aOR 4.48; 95% CI: 2.32-8.62). Conclusion: Most women with ovarian tumours were young, and a significant proportion had benign tumours, highlighting the need for a more thorough diagnostic assessment. Improved gynaecological ultrasound scanning, access to intraoperative pathology consultation and molecular testing will be essential for guiding ovarian cancer care in Ghana.