Diagnostic delay of gynaecological cancer in women with postmenopausal bleeding.

INTRODUCTION

Postmenopausal bleeding is the primary reason for referral to the gynaecological fast-track suspected cancer programme due to an elevated risk of endometrial cancer. The aim of this study was to examine the diagnostic flow among women with postmenopausal bleeding.

METHODS

Data were collected and analysed from 362 women at Sygehus Sønderjylland referred with the International Classification of Diseases, tenth edition, diagnosis "DN950 postmenopausal bleeding" from 2015 to 2019.

RESULTS

We found a mean 83-day period between the initial consultation and the final cancer diagnosis. Combined, the 362 women underwent 354 diagnostic procedures of which 204 were endometrial sampling with aspiration (vabrasio). In 44% of the cases, sampling by vacuum aspirator was either unsuccessful due to pain or cervical stenosis or was deemed insufficient for pathological assessment. Gynaecological cancer was diagnosed in 16 (4%) of the women, hereof 13 (3.6%) had endometrial cancer.

CONCLUSIONS

We found a remarkable delay not complying with the intentions of national guidelines with respect to final diagnostics of endometrial cancer. Vacuum aspirator is a frequently used diagnostic tool, but has shortcomings in relation to the success rate of the procedure and insufficient sampling. Gynaecological cancer was found at a rate of 3-5% as reported by other Danish studies. Because of the limitations associated with a one-step diagnostic procedure with vabrasio, attention to follow-up may reduce diagnostic delay.

FUNDING: none.

TRIAL REGISTRATION: This study was registered with the Region of South Denmark (no. 21/18387) and Sygehus Sønderjylland (no. 1298-001) as a quality improvement project.