title: Gynecological cancer alarm symptoms: is contact with specialist care associated with lifestyle and socioeconomic status? A population-based study.
abstract: BACKGROUND
  The aim of this study was to determine the proportion of patients who were referred to specialist care after reporting gynecological cancer alarm symptoms to their general practitioner. We sought to investigate whether contact with specialist care was associated with lifestyle factors or socioeconomic status.
  
  
  METHODS
  Nationwide population-based prospective cohort study in Denmark, based on a random sample of 51 090 women aged 20 years or older from the general population. A web-based questionnaire regarding gynecological alarm symptoms and lifestyle was distributed to the invited individuals. Data about contact with specialist care were obtained from the National Patient Register and the National Health Insurance Service Registry, whereas information about socioeconomic status was collected from Statistics Denmark. Main outcome measures were percentages of patients having contact with specialist care and odds ratios (ORs) for associations between specialist care contact, lifestyle factors and socioeconomic status.
  
  
  RESULTS
  The study included 25 866 nonpregnant women; 2957 reported the onset of at least one gynecological cancer alarm symptom, and 683 of these (23.1%) reported symptoms to their general practitioner. The proportion of individuals having contact with specialist care ranged from 39.3% (pain during intercourse) to 47.8% (bleeding during intercourse). Individuals with higher educational level had significantly higher odds of contact with a specialist (OR 1.86, 95% CI 1.17-2.95).
  
  
  CONCLUSIONS
  Educational level influences contact with specialist care among patients with gynecological cancer alarm symptoms. Future studies should investigate inequalities in access to the secondary healthcare system.
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Kirubakaran
authors.identifier: http://orcid.org/0000-0002-3612-1731
authors.initials: K
authors.lastname: Balasubramaniam
authors.affiliation: Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Ravn
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Rene D
authors.initials: RD
authors.lastname: Christensen
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Søndergaard
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Dorte E
authors.initials: DE
authors.lastname: Jarbøl
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003075:Coitus; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D058005:General Practitioners; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010342:Patient Acceptance of Health Care; D017699:Pelvic Pain / Q000209:etiology; D017698:Postmenopause; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012923:Social Class; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000209:etiology
keywords: Gynecological cancer; lifestyle; socioeconomic status; specialist care; symptoms