Gender inequalities in emergency colon cancer diagnosis: A longitudinal data-linkage study in England on pre-diagnostic clinical history and healthcare use


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Cristina Renzi1,Georgios Lyratzopoulos1,Bernard Rachet2
1UCL,2LSHTM

Abstract

Background

A third of colon cancers in England are diagnosed as an emergency, with women being at higher risk than men. We aimed to evaluate the role played by differential healthcare use and clinical characteristics in influencing gender inequalities in emergency colon cancer diagnosis.

Method

Cohort study on 5,745 incident colon cancers diagnosed in England 2005-2010, with individually linked cancer registry, primary and secondary care data providing clinical information on up to 10-years pre-diagnosis.

Results

Colon cancer was diagnosed as an emergency in 34% of women and 30% of men. Among both genders, primary care consultation patterns between 10 and 2 years pre-diagnosis were similar among emergency and non-emergency presenters. During the year before the diagnosis, consultation rates increased markedly, independently of diagnostic routes. Women and older patients had higher consultation rates for relevant symptoms in the pre-diagnostic year. Anaemia, abdominal pain, constipation, diarrhoea and fatigue were recorded more frequently in women. Among women diagnosed as an emergency, 20% had red-flag symptoms (anaemia, rectal bleeding, change in bowel habits) during the pre-diagnostic year, versus 15% among men (p=0.002). Women more often received a benign diagnosis (irritable bowel syndrome or diverticular disease): 6% versus 2% among women and men diagnosed as an emergency (p<0.001). Multivariable analysis showed that emergency diagnosis was more likely in older and deprived men and women, independently of clinical history, symptoms, cancer sub-site and comorbidities. A benign diagnosis increased the risk of emergency presentation only among women (OR=1.54; 95%CI 1.1-2.3). Red flag symptoms and specialist referrals decreased the risk.  

Conclusion

Women have an increased risk of emergency diagnosis despite more frequent relevant consultations. This might be due to less specific symptoms and their more frequent attribution to benign diagnoses. One in five women diagnosed as an emergency had red flag symptoms and multiple relevant consultations highlighting opportunities for earlier diagnosis.