Is gynaecological cancer stage affected by pre-referral pelvic examination: a linked data study?


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Pauline Williams1,Peter Murchie1,Maggie Cruickshank1,Christine Bond1,Chris Burton2,Dolapo Ayansina1
1University of Aberdeen,2University of Sheffield

Abstract

Background

Urgent suspected cancer (USC) guidelines recommend that pelvic examination (PE) should be an integral part of the pre-referral diagnostic journey for patients with a suspected gynaecological cancer. However, no evidence is cited to justify this (1, 2). It is unclear whether pre-referral PE (PRPE) improves outcomes for these patients and it is often not performed (3, 4). This study aimed to determine: 1) The rate of PRPE and the factors associated with it and 2) The association between PRPE and cancer stage at diagnosis.

Method

A data linkage study in NHS Grampian, combining primary care records of women diagnosed with a gynaecological cancer between 2006 and 2017 with secondary care data from the NHS Grampian Cancer Care Pathway database. Recruitment was at GP practice level; 24 practices were invited (12 urban/12 rural). Primary care data were collected onto a digital pro-forma and de-identified prior to linkage.

Results

Data from 328 patients was collected from 15 recruited practices (8 urban/7 rural). 55.4% of patients had PRPE. 55.5% of patients were diagnosed at Stage1/2; 53% presented with at least one gynaecological symptom.Logistic regression, adjusting for age, presence of at least one gynaecological symptom and cancer type revealed statistically significant associations between PRPE and early stage at diagnosis (OR 3.9; 95% confidence interval[CI] 2.1-7.2; P <0.0001) ; PRPE and at least one gynaecological symptom (OR 8.2; 95%CI 4.8-14.0; P <0.0001). There was no association between age and PRPE. Increasing age and non-gynaecological symptoms were associated with stage 3/4 diagnosis (OR 1.03; 95% CI 1.01-1.06; P< 0.05) (OR 4.7; 95%CI 2.1-10.4; P <0.0001) respectively.

Conclusion

PRPE is a potentially important modifiable factor in early stage gynaecological cancer diagnosis. Further research should explore why it is frequently not done in primary care prior to referral in women subsequently diagnosed with gynaecological cancers.