Centralisation of services for the management of ovarian cancer: arguments against.

In 2000, the Commissioning Guidance for gynaecological cancer services relied on a subset analysis within a retrospective study to support its requirement that surgery for carcinoma of the ovary be centralised. We have reviewed the literature covering this issue, especially that published in the past 6 years. There is no evidence for an advantage for specialist gynaecological oncologists over general gynaecologists for these women; studies that suggest that one exists fail to separate patients presenting to general surgeons, whose patients are at a clear disadvantage, from those seen by gynaecologists. There is evidence for the need for appropriate surgery in women with less extensive disease where the diagnostic difficulties are greatest. We argue for investment in the diagnosis of ovarian cancer and the provision of services for its medical treatment over a prolonged period.