title: Delays in diagnosis of young females with symptomatic cervical cancer in England: an interview-based study.
abstract: BACKGROUND
  Diagnosis may be delayed in young females with cervical cancer because of a failure to recognise symptoms.
  
  
  OBJECTIVE
  To examine the extent and determinants of delays in diagnosis of young females with symptomatic cervical cancer.
  
  
  METHODS
  A national descriptive study of time from symptoms to diagnosis of cervical cancer and risk factors for delay in diagnosis at all hospitals diagnosing cervical cancer in England.
  
  
  METHODS
  One-hundred and twenty-eight patients <30 years with a recent diagnosis of cervical cancer were interviewed. Patient delay was defined as ≥3 months from symptom onset to first presentation and provider delay as ≥ 3 months from first presentation to diagnosis.
  
  
  RESULTS
  Forty (31%) patients had presented symptomatically: 11 (28%) delayed presentation. Patient delay was more common in patients <25 than patients aged 25-29 (40% versus 15%, P = 0.16). Vaginal discharge was more common among patients who delayed presentation than those who did not; many reported not recognising this as a possible cancer symptom. Provider delay was reported by 24/40 (60%); in some no report was found in primary care records of a visual inspection of the cervix and some did not re-attend after the first presentation for several months. Gynaecological symptoms were common (84%) among patients who presented via screening.
  
  
  CONCLUSIONS
  Young females with cervical cancer frequently delay presentation, and not recognising symptoms as serious may increase the risk of delay. Delay in diagnosis after first presentation is also common. There is some evidence that UK guidelines for managing young females with abnormal bleeding are not being followed.
authors.affiliation: Kings College London Promoting Early Cancer Presentation Group, King's College London, London.
authors.forename: Anita W
authors.initials: AW
authors.lastname: Lim
authors.affiliation: Kings College London Promoting Early Cancer Presentation Group, King's College London, London.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ramirez
authors.affiliation: University of Exeter Medical School, Primary care diagnostics, Exeter.
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts & The London School of Medicine and Dentistry, London.
authors.forename: Peter
authors.initials: P
authors.lastname: Sasieni
authors.affiliation: Public Health England, NHS Cancer Screening Programmes, Sheffield.
authors.forename: Julietta
authors.initials: J
authors.lastname: Patnick
authors.affiliation: Kings College London Promoting Early Cancer Presentation Group, King's College London, London.
authors.forename: Lindsay Jl
authors.initials: LJ
authors.lastname: Forbes
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D057189:Checklist; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D004414:Dyspareunia / Q000175:diagnosis* / Q000209:etiology; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006176:Gynecology; D006801:Humans; D007407:Interviews as Topic; D008487:Medical History Taking / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D063127:Secondary Health Care; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D019522:Vaginal Discharge / Q000175:diagnosis* / Q000209:etiology
keywords: cervical cancer; delays; early diagnosis; symptoms; young females