title: Risk of uterine cancer in symptomatic women in primary care: case-control study using electronic records.
abstract: BACKGROUND
  Uterine cancer is the fourth most common cancer in women in the UK, with approximately 7700 new diagnoses and 1700 deaths annually.
  
  
  OBJECTIVE
  To identify and quantify features of uterine cancer in primary care.
  
  
  METHODS
  Case-control study using electronic primary care records in primary care in the UK.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Walker
authors.forename: Chris
authors.initials: C
authors.lastname: Hyde
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D055088:Early Detection of Cancer / Q000379:methods*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment / Q000379:methods; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000175:diagnosis*; D019522:Vaginal Discharge / Q000209:etiology