Gender inequalities in the diagnosis of bladder and kidney cancer – the story behind the paper

Together with colleagues at the Universities of Durham and Bangor and the PHE’s National Cancer Intelligence Network, today we published a paper in BMJ Open (see Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey. BMJ Open 2013;3:e002861 doi:10.1136/bmjopen-2013-002861. Here is the story behind the paper.

Early in 2012 we published a paper that, among other findings, indicated that the promptness of diagnosis of patients with bladder and kidney cancer varies by gender: Women with those cancers experienced three or more pre-referral consultations with their general practitioner substantially more often than did men with the same cancers. For that paper, we used data that were reported by many thousands of cancer patients who took part in the 2010 Cancer Patient Experience Survey. This finding was interesting, but did not raise much attention – perhaps inadvertently obscured by the rest of the findings and the length of the paper (6,500 words, 2 tables, 6 figures, and many pages of online appendices).

People who are familiar with the work of John Ioannidis would know that most dramatic findings in biomedicine represent either biased or chance findings and are usually never replicated. However, every rule has its exceptions: The National Audit of Diagnosis in Primary Care provided us with a unique opportunity to further explore whether gender inequalities in the diagnosis of urinary tract cancers were replicable in a survey with a very different sample and methods of data collection. Using data from this national audit survey, we have also been able to amplify and deepen our previous inquiry. For example we were able to look at both the number of pre-referral consultations and the time period between presentation and referral – i.e. the primary care interval. We were also able to explore whether women and men with urinary tract cancers present with macroscopic haematuria (a ‘red flag’ symptom) with similar frequency, and whether the presence or absence of haematuria can be responsible for the observed inequalities in the promptness of diagnosis.

Briefly, the answer to the question “were the previous findings replicable” is an emphatic “yes”. Our research also identifies opportunities for diagnosing urinary tract cancers in women earlier, although it also highlights challenges ahead about diagnosing cancer promptly in patients (of either gender) who present without red flag symptoms.

You can also read how the paper was covered by the Telegraph, the BMJ and also the actual paper here. There has also been coverage by NHS Choices see ow.ly/mp6rE , NEJM’s Journal Watch http://shar.es/AWh8l and Medscape http://www.medscape.com/viewarticle/806989.

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