Non-invasive diagnostic techniques for endometrial cancer in primary care (PhD)

Introduction

Womb or endometrial cancer is the most common gynaecological cancer in the UK and its incidence is rising. Although most women are treated successfully with surgery, one in five women are diagnosed with advanced womb cancer when cure is unlikely. If we could diagnose all of these cancers early, we would save lives.

For most women, the first symptom of womb cancer is postmenopausal bleeding. For 90% of women, this bleeding is nothing serious, however, all women undergo a series of tests to exclude womb cancer. These include an internal ultrasound scan, a camera test and a biopsy. Some women find the tests intrusive and painful, which may be one reason why women with postmenopausal bleeding do not see their GP straight away.
A new test for womb cancer that is quick, accurate and patient-friendly could help.

Aims & objectives

The overall aim of this study is to develop a non-invasive urogenital test (e.g. urine and/or vaginal sampling) for endometrial cancer that is feasible, accurate and acceptable to patients and health care professionals in the primary care setting. The objectives of the research are:

1. To determine the feasibility of urogenital sampling for endometrial cancer detection in Primary Care
2. To determine the acceptability of urogenital sampling to women using a multi-method approach
3. To determine the acceptability of urogenital sampling to health care professionals using a multi-methods approach

Methodology

We will recruit up to 100 women from up to five GP Practices. We will determine the feasibility of using urogenital non-invasive testing in Primary Care by asking GPs and Practice Nurses to obtain urogenital samples from women presenting with postmenopausal bleeding. We will keep a record of indicators of feasibility including the number of eligible women per practice per week or month, recruitment rate to the study, reasons for non-participation in the study, number of samples obtained/woman (whether just urine, just vaginal or both samples obtained), reasons for missing samples, whether samples were taken correctly by the primary care clinician and whether samples were received by the lab as well as adequacy of the samples.

We will also assess the acceptability of our test through a questionnaire for patients and healthcare professionals providing the test. We will ask a purposive sample to participate in a semi-structured qualitative interview to gain an insight into the acceptability of our new non-invasive test.

Outputs & impact

A large multicentre diagnostic test accuracy study of the new test is also underway in Secondary Care. If our tests are accurate, it could be performed in Primary Care to help GPs decide which women need a specialist referral and which can be safely reassured.

Next steps

The next steps of our study are the recruitment of participants, sample collection, performance of questionnaires and interviews. Following this, an in-depth data analysis will be performed.