Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey
Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. BMJ Open. 2013 Jun 24;3(6). pii: e002861. doi: 10.1136/bmjopen-2013-002861. Print 2013.

Source

Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.

Abstract

OBJECTIVES:

To explore whether women experience greater delays in the diagnosis of bladder and renal cancer when first presenting to a general practitioner with symptoms caused by those cancers and potential reasons for such gender inequalities.

DESIGN:

Prospective national audit survey of cancer diagnosis.

SETTING:

English primary care (2009-2010).

PARTICIPANTS:

920 patients with bladder and 398 patients with renal cancer (252 (27%) and 165 (42%), respectively, were women).

PRIMARY AND SECONDARY OUTCOME MEASURES:

Proportion of patients with three or more pre-referral consultations; number of days from first presentation to referral; proportion of patients who presented with haematuria and proportion of patients investigated in primary care.

RESULTS:

Women required three or more prereferral consultations more often than men (27% (95% CI 21% to 33%) vs 11% (9% to 14%) for bladder (p<0.001); and 30% (22% to 39%) vs 18% (13% to 25%) for renal cancer (p=0.025)) and had a greater number of days from presentation to referral. In multivariable analysis (adjusting for age, haematuria status and use of primary care-led investigations), being a woman was independently associated with higher odds of three or more pre-referral consultations (OR=3.29 (2.06 to 5.25, p<0.001) for bladder cancer; and OR=1.90 (1.06 to 3.42, p=0.031) for renal cancer). Although presentation with haematuria was associated with more timely diagnosis of bladder cancer, gender inequalities did not vary by haematuria status for either cancer (p=0.18 for bladder and p=0.27 for renal). Each year in the UK, approximately 700 women with either bladder or renal cancer experience a delayed diagnosis because of their gender, of whom more than a quarter (197, or 28%) present with haematuria.

CONCLUSIONS:

There are notable gender inequalities in the timeliness of diagnosis of urological cancers. There is a need to both reinforce existing guidelines on haematuria investigation and develop new diagnostic decision aids and tests for patients who present without haematuria.