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Women with urinary cancers missing out on prompt diagnosis

Around 700 women in England with symptoms of kidney or bladder cancer are missing out on prompt diagnosis and treatment every year, reveals research in the online only journal BMJ Open, co-authored by Professor Richard Neal, North Wales Centre for Primary Care Research at Bangor University.

This research suggests that this may be because family doctors tend to attribute women’s - rather than men’s - initial symptoms to harmless causes, such as bacterial infections, and some women therefore have to visit their GP several times before they get referred to a specialist.

Currently, survival rates for kidney and bladder cancer in England show that fewer women than men live for five years after diagnosis.

The researchers looked at the numbers of patients diagnosed with kidney and bladder cancers in England between 2009 and 2010. They used data from the National Audit of Cancer Diagnosis in Primary Care, covering 1170 representative general practices - equivalent to around 14% of the national total.

They looked at two interrelated measures of the promptness of diagnosis: the number of consultations the patient made before s/he was referred; and the time interval between the first visit to the GP with symptoms and specialist referral. Their analysis showed that women were around twice as likely as men to have visited their GP on three or more occasions before they were referred to a specialist.

Two thirds of all patients with bladder cancer and one in four of those with kidney cancer had blood in their urine, a red flag symptom for further investigation. But the analysis indicated that the presence or absence of this symptom could not account for the gender difference in referral times.

Even when patients came to see their GP with blood in their urine, women with bladder cancer were more than three times as likely to have three or more GP visits before referral compared with men with the same symptom. Additionally, women with kidney cancer were almost twice as likely as men to experience three or more consultations, when they had blood in their urine.

Professor Neal said: “Reinforcing the need to follow guidelines and view blood in the urine as suspicious might prompt GPs to refer women more quickly, but it won’t help in those cases where this symptom is absent, we need a new approach to tackle this issue.

“Our findings signal a large potential for improving the timeliness of diagnosis of urinary tract cancer in women, interventions to help GPs avoid initial misdiagnosis of haematuria in women with urinary tract cancer to benign causes need to be promptly developed and evaluated.”

As almost 3000 women are diagnosed with kidney cancer and 3000 women diagnosed with bladder cancer every year in England, the authors calculate that around 700 women will experience delayed diagnosis.

Publication date: 25 June 2013