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However, it is likely that failure to identify patients who might be suitable for surgery has been at least part of the problem.
Even those found to be suitable for surgery usually present with stage III disease (at least T3 with lymph node metastases).
These studies address the timing of surgery relative to chemotherapy for newly diagnosed ovarian cancer and women believed to be suitable for surgery at diagnosis were randomised to receive either surgery followed by chemotherapy or neoadjuvant therapy followed by IDS.
Co-morbidity could explain part of this relationship as we would expect greater levels of co-morbidities in men in the more deprived areas and therefore these men will be less likely to be suitable for surgery.
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However, only 20% of patients are suitable for surgery.
The indications for surgery included symptomatic tumors which are suitable for surgery and asymptomatic cases with evidence of tumor growth.
Currently, surgery is the only treatment although, due to its late presentation, only 9 15%% of the patients are suitable for surgery.
Surgical excision can sometimes cure, but only one in five people is suitable for surgery because the size and location of tumors can make removal impossible without endangering the patient.
4 Less than 50% of patients are suitable for surgery, which is the only curative modality.
There is a selection bias because conservatively treated patients were not regarded as being suitable for surgery.
However, not all patients are suitable for surgery, and others may be concerned about undergoing an invasive procedure.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com