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Impact of Ovarian Cancer Screening Services on Ovarian Cancer Detection among High-Risk Women in Nigeria

Abstract

Ovarian cancer is an important women's health concern and may be associated with substantial morbidity and mortality because it is frequently detected at an advanced stage. Women with certain risk factors, including a strong family history of ovarian or related cancers and identified hereditary cancer-risk conditions, may require individualized assessment and appropriate clinical management. Early recognition of concerning symptoms and appropriate evaluation of women at increased risk may support timely diagnosis and treatment. However, access to ovarian cancer risk assessment and diagnostic services in Nigeria may be limited by inadequate awareness, financial barriers, geographical constraints, limited specialist services, insufficient diagnostic capacity, and weak referral pathways. Although there is no established population-wide screening test proven to reduce ovarian cancer mortality in average-risk women, high-risk women may require individualized risk assessment, genetic counselling where appropriate, specialist evaluation, and carefully considered surveillance or diagnostic investigation. Against this background, this study investigates the impact of ovarian cancer screening and risk-assessment services on ovarian cancer detection among high-risk women in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how high-risk women's perceptions of their susceptibility to ovarian cancer, perceived severity, perceived benefits of appropriate assessment, perceived barriers, and cues to action may influence utilization of available services. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and perceived healthcare needs influence women's utilization of cancer-related healthcare services. The Social Ecological Model emphasizes the interaction between individual, family, community, healthcare-system, and broader societal factors in determining access to cancer risk assessment and diagnostic services. Collectively, these theoretical perspectives provide a suitable framework for explaining how appropriate ovarian cancer risk-assessment and diagnostic services may influence cancer detection among high-risk women in Nigeria. The study will adopt a quantitative analytical cross-sectional or retrospective cohort research design. The study population will comprise women identified as being at increased risk of ovarian cancer through relevant family history, hereditary cancer-risk assessment, previous clinical assessment, or other established risk criteria and attending selected tertiary hospitals, oncology centres, gynaecological clinics, genetic counselling services, and specialist healthcare facilities across Nigeria. A multistage or purposive sampling technique will be used to select participating healthcare facilities and eligible high-risk women. Ovarian cancer risk-assessment and diagnostic services will be assessed using indicators such as availability of specialist assessment, genetic counselling where appropriate, access to gynaecological evaluation, clinical assessment of concerning symptoms, referral pathways, diagnostic imaging where clinically indicated, laboratory investigations where appropriate, specialist consultation, and follow-up services. Ovarian cancer detection will be assessed using indicators such as suspected cases identified, diagnostic investigations completed, confirmed ovarian cancer cases, stage at diagnosis, referral completion, and time from initial assessment to diagnostic confirmation. Data will be collected using structured questionnaires, medical records, oncology registers, pathology reports, imaging records, referral registers, and relevant hospital records. Descriptive statistics will be used to summarize participants' characteristics, risk profiles, utilization of assessment services, diagnostic findings, and patterns of ovarian cancer detection. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of access to appropriate ovarian cancer risk-assessment and diagnostic services on detection. Where longitudinal records are available, detection outcomes among women who utilized specialist assessment services may be compared with those who had limited or delayed access to determine associations with earlier detection. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that access to appropriate ovarian cancer risk assessment, specialist evaluation, and timely diagnostic services has a significant positive impact on ovarian cancer detection among high-risk women in Nigeria. High-risk women who receive timely risk assessment and appropriate clinical evaluation are expected to have a greater likelihood of concerning findings being identified and investigated than women who experience limited access to specialist services. Genetic counselling and individualized risk assessment may help identify women who require closer clinical attention, while timely evaluation of persistent or concerning symptoms may facilitate diagnostic investigation. However, financial constraints, limited availability of oncology and genetic services, shortage of specialists, inadequate diagnostic facilities, geographical barriers, delayed referrals, and limited awareness of hereditary cancer risk may reduce timely detection. The study therefore expects accessible, evidence-based, individualized, and well-coordinated risk-assessment and diagnostic services to contribute to improved detection of ovarian cancer among high-risk women in Nigeria. The study is expected to contribute to the literature on ovarian cancer risk assessment, ovarian cancer detection, women's cancer health, hereditary cancer risk, genetic counselling, gynaecological oncology, cancer diagnosis, specialist healthcare utilization, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, tertiary hospitals, oncology centres, gynaecological services, genetic counselling providers, healthcare professionals, women's health organizations, development partners, and policymakers regarding strategies for improving the identification and management of women at increased ovarian cancer risk. The study will also provide evidence-based recommendations for strengthening hereditary cancer risk assessment, expanding access to specialist gynaecological and oncology services, improving referral pathways, increasing awareness of ovarian cancer risk factors and concerning symptoms, strengthening diagnostic capacity, and ensuring timely follow-up and management for high-risk women across Nigeria.

Keywords: Ovarian cancer, risk assessment, ovarian cancer detection, high-risk women, genetic counselling, gynaecological oncology, cancer diagnosis, specialist healthcare, women's health, cancer prevention, Nigeria, public health.