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Oncology outcomes

How do women make sense of possible gynaecological cancer symptoms?

Low EL, Whitaker KL, Simon AE, et al. · BMJ open · 2015

Open access · cc by · source: Europe PMC

Women mostly explained away possible warning symptoms as normal parts of being female, ageing or taking contraception, and tended to manage them at home or ask family rather than see a doctor.

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Study at a glance

Design
Qualitative / archival — Semistructured interviews (face-to-face or phone) with community women who reported recent possible gynaecological cancer symptoms, analysed thematically and mapped onto the Model of Pathways to Treatment; cancer was never mentioned by the interviewer.
N
N=26 · 26 women interviewed, purposively selected from 70 eligible respondents to an online screening questionnaire answered by 123 women.
Population
Women in London, recruited in 2012 through non-medical online and community settings, who had experienced at least one of 14 possible gynaecological cancer symptoms in the previous 3 months; mostly White British, highly educated and higher socioeconomic status.
Outcome
Themes describing how women interpreted their symptoms (appraisal) and what they did about them (help-seeking).

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Key findings

Women often normalised symptoms, linking them to periods, menopause, diet, age, hormonal contraception, existing conditions such as fibroids, or family history; when cancer came to mind it was usually dismissed as unlikely. Common responses were self-management (for example, changing diet), setting high personal tipping points before acting, and consulting family and friends. Worsening or persistent symptoms and awareness of a cancer link triggered help-seeking, while competing demands, fear of wasting the GP's time, difficulty getting appointments, previous negative tests and embarrassment with a male GP held it back.

Methodology

The researchers used an online questionnaire, shared through websites and community posters, to find London women who had recently had symptoms that could indicate gynaecological cancer. They interviewed 26 of them in depth about what they thought caused each symptom and what they did, without ever mentioning cancer. Transcripts were coded thematically and the themes were sorted into the appraisal and help-seeking stages of the Model of Pathways to Treatment.

Limitations

The sample was small and homogeneous: most participants were White British, degree-educated and from higher socioeconomic groups, and the planned low-SES group could not be recruited, so other themes might emerge in more diverse women. As a qualitative study it describes the range of reasoning but cannot say how common each response is or whether it actually delays cancer diagnosis. Participants were self-selected online volunteers, and most of their symptoms were probably benign, so the findings concern everyday symptom interpretation rather than women who turned out to have cancer.

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