Womb cancer is the most common of the five gynae cancers, and the fourth most common cancer in women. It can also be called uterine cancer or endometrial cancer.
It affects 9,700 women and people with gynae organs a year in the UK and it is on the rise- diagnoses have gone up by 41% since 2001 in England. Until now, there has been no national monitoring of womb cancer care and outcomes in England. In partnership with the British Gynaecological Cancer Society and Peaches Womb Cancer Trust, we have co-funded a pilot audit on womb cancer care.
We hope that the data reported in this audit can help shine a light on where improvements can be made in the womb cancer pathway, and can help reduce inequalities and improve outcomes for all patients with womb cancer.
The report looked at NHS data from patients who were diagnosed with womb cancer between 2017-2019. 23,388 women and people with gynae organs were diagnosed with womb cancer in this timeframe.
Womb cancer diagnosis
The report launched today has highlighted some of the inequities in womb cancer diagnosis and the impact it is having. Understanding the routes to diagnosis is important and can help guide improvements to help women and people with womb cancer get diagnosed at an earlier stage, when both their outcomes and experience are better.
We know from previous research that the route to diagnosis is linked to the stage of the cancer at diagnosis, which impacts what treatment options are available and how likely someone is to survive their cancer. This is especially apparent if people are diagnosed after going to A&E, when they are more likely to be diagnosed late and have a worse outcome.
The report found the most common route people were diagnosed through was the urgent suspected cancer pathway referral (often called the two-week wait), 61.7% of people were diagnosed this way.
The second most common route to diagnosis was through other types of GP referrals, which was 23% of patients. These other GP referrals include routine referrals to gynaecology, or to other specialities where the patient wasn’t put through the two-week referral system for a suspected cancer.
The third most common route to being diagnosed was through ‘emergency presentation’, which is when someone is diagnosed after visiting A&E. 6.9% of those diagnosed had been to A&E before their diagnosis.
Variation in route to diagnosis
The report found that you were more likely to be diagnosed after visiting A&E if you were 80 years old or more. 14.6% of those diagnosed through emergency presentation had been in this age bracket.
The report also found you were more likely to be diagnosed through other GP referrals and not the two week wait urgent referral if you were younger, which may be from younger women and people with abnormal bleeding being referred to gynaecology or fertility services, and not having cancer suspected as the cause.
There were some inequalities in route to diagnosis depending on where you lived in the country, your ethnicity, whether you had any other health issues, and what socioeconomic group you were from.
Black women were more likely than any other ethnic group to be diagnosed in A&E. The number of people diagnosed through A&E was also higher if they were from a more deprived area in the country, compared to those in the least deprived areas.
What this means for patients
The report found a link between being diagnosed through A&E and cancer being at a later stage. Out of the people diagnosed through A&E, 1 in 4 (25.1%) of them were stage 4, and just 3% of them were stage 1.
Over 1 in 5 (22.8%) of them were diagnosed with stage unknown, which was much more than the 6% of women diagnosed through other routes. When someone is diagnosed with stage unknown it may mean that by the time they were diagnosed, they may have been too unwell to go through the procedures needed to stage the cancer.
Our hopes for the future
We hope that this audit pilot will be the first of many. Knowing what is happening across the country and having a clear picture of the data helps us understand the issues women face getting diagnosed with, and treated for, womb cancer. We hope this vital information can help guide improvements. It is clear from this audit that there are inequalities across womb cancer care, and our focus must be on reducing those, so that every woman and person with womb cancer gets diagnosed as early as possible, has access to the right treatments and has the best possible chance of surviving their cancer.
This audit was only possible because of collaboration and we want to thank the British Gynaecological Cancer Society and Peaches Womb Cancer Trust for working with us and making it possible.
Acknowledgements
This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS England.
