Cervical cancer screening, or the “smear test”, aims to pick up and treat abnormal cells in the cervix before they become cancer. But for most gynaecological cancers there isn’t a screening programme, so noticing symptoms and getting them checked out is the key to making sure cancer can be diagnosed at an early stage when treatment is most effective.
In a new research paper published in BMJ Open, we tried to understand how women notice and make sense of symptoms that might indicate a gynae cancer. There are five of these cancers, affecting the cervix, womb, ovary, vagina and vulva. They have a range of symptoms, many of which are common and can be a sign of much less serious conditions – things like bloating, bleeding between periods or after sex, and changes in bowel habits.
In order to find out how people would interpret these symptoms if they had them, we interviewed 26 women who’d had these kinds of symptoms to see what they thought had caused them, and what they’d done about them. Generally, and understandably, most women assumed that the symptoms were caused by everyday things such as diet, the contraceptive pill, menopause or pre-existing conditions like fibroids. We didn’t mention cancer in the interviews, and nor did most of the women taking part.
One participant whose periods had become longer than usual, said: “I have a contraceptive implant which can cause irregular bleeding … It never caused me any trouble and suddenly all this. So that could be one of the reasons.”
Most women in our study tried to manage the symptoms themselves, or talked to friends or family about them, rather than going to their doctor. They only tended to see their GP if the symptoms got worse or became persistent.
Each year in the UK, more than 20,000 women are diagnosed with gynaecological cancer. The most common one is endometrial (womb) cancer, with over 8,000 new cases; the rarest is vaginal cancer with about 250. Overall, over 7,500 women die of these diseases, and survival is linked with stage at diagnosis. Over 90% of women diagnosed with Stage 1 cervical cancer, for example, survive for at least five years, compared with just 5% of those with Stage 4 disease. So it’s really important that these cancers are picked up and treated as early as possible.
Our study highlights the essential conundrum of cancer symptoms, which is that the symptoms that indicate cancer are often quite common, and in most cases will be have a much less serious explanation. But if we ignore them completely, or until they become debilitating, we risk diagnosing cancer at a later stage when treatment might be more aggressive and less effective. The difficult thing is finding the balance between rushing to the doctor for every twinge, and leaving it too late when something is really wrong.
Cancer Research UK has developed guidelines with common symptoms (not just gynaecological) and timescales to help people decide when it’s appropriate to go to the doctor and get a symptom checked out. For example, with bloating, they suggest you make an appointment if you’ve been bloated on most days for at least three weeks. This should be useful for people worrying about whether their symptom is serious enough to warrant “bothering” their GP, which is sometimes a barrier to making an appointment.
Jo Waller receives funding from Cancer Research UK.