Case-control study using electronic primary care records in primary care in the UK.
METHOD: Putative features of
uterine cancer were identified in the year before diagnosis, and odds ratios (
ORs) calculated using conditional logistic regression. Positive predictive values (PPVs) were calculated for women who consulted.
RESULTS: A total of 2732 women aged ≥40 years with
uterine cancer between 2000 and 2009, and 9537 age-, sex- and practice-matched controls were selected from the General Practice Research Database. The median age at diagnosis was 67 years. Nine features were significantly associated with
uterine cancer: postmenopausal
bleeding (OR = 160; 95% confidence interval [CI] = 100 to 240), excessive
vaginal bleeding (OR = 22; 95% CI = 12 to 42),
irregular menstruation (OR = 42; 95% CI = 27 to -63),
vaginal discharge (OR = 14; 95% CI = 10 to 21), haematuria (OR = 8.7; 95% CI = 5.0 to 15),
abdominal pain (OR = 2.0; 95% CI = 1.4 to 2.8), low haemoglobin (OR = 2.1; 95% CI = 1.5 to 2.9), raised platelets (OR = 1.5; 95% CI = 1.0 to 2.3), and raised
glucose (OR = 1.4; 95% CI = 1.1 to 1.8); all P<0.01, other than raised platelets, P = 0.05 and raised
glucose, P = 0.02. In the year before diagnosis, 1725 (63%) cases had a record of abnormal
vaginal bleeding compared to 135 (1%) controls. The PPV of
uterine cancer with postmenopausal
bleeding was 4%, and was higher in women with multiple or repeated symptoms.
CONCLUSION: This study confirms the importance of several features, particularly postmenopausal
bleeding, for
uterine cancer. Haematuria is an important risk marker. The results of this study may inform GPs in the selection of women for investigation and should assist the NICE in their update of GP referral guidance.