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Reasons for Diagnostic Delay in Gynecological Malignancies
  1. Mai Partridge Vandborg, MD*,,
  2. René dePont Christensen, PhD,
  3. Jakob Kragstrup, DMSc,
  4. Kasper Edwards, PhD,
  5. Peter Vedsted, PhD§,
  6. Dorte Gilså Hansen, PhD and
  7. Ole Mogensen, DMSc*
  1. *Department of Gynecology and Obstetrics, Odense University Hospital, and
  2. Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark;
  3. Department of Management Engineering, Technical University of Denmark, Lyngby, Denmark;
  4. §Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Aarhus, Denmark; and
  5. Research Unit of General Practice, National Research Center of Cancer Rehabilitation, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
  1. Address correspondence and reprint requests to Mai Partridge Vandborg, MD, Department of Gynecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C DK-5000, Denmark. E-mail: mvandborg{at}


Introduction: To describe the different delay types in women with gynecological cancer and to analyze the relationship between diagnostic delay and a number of characteristics for patients, cancers, and the health care system.

Method: Data were obtained from 4 different questionnaires, the Electronic Patient Journal (EPJ), and the Danish Gynecological Cancer Database (DGCD). A total of 161 women with ovarian cancer (63), endometrial cancer (50), cervical cancer (34), and vulvar cancer (14) were included. Outcome measures were different delay types counted in days and 4 clinically important variables' impact on the diagnostic delay: presence of alarm symptoms, age (divided into 2 groups: ≤60 or >60 years), performance of gynecological examination by the general practitioner (GP), and notification of cancer suspicion on first referral from GP.

Results: Across cancer types, median total delay was 101 days. Some 10% of women experienced the longest delay with a total delay of 436 days or more. Vulva cancer had the longest delay, whereas women with ovarian cancer had the shortest delay. More than one third (39%) of the women consulted their GP for reasons other than the predefined alarm symptoms. Gynecological examination by the GP was less likely to be performed if the woman did not present with vaginal bleeding. The length of the delay was shortened by performance of a gynecological examination by the GP and a primary referral from the GP raising the receiver's suspicion of cancer.

Conclusion: Reducing diagnostic delays should be achievable, particularly for those most delayed, and interventions aimed at reducing delays need to be developed. Creation of new valid instruments for measuring delay is essential in future research.

  • Gynecological malignancies
  • Delay
  • Alarm symptoms
  • Cancer suspicion

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  • This study was supported by the Novo Nordic Foundation and the Ministry of Interior and Health.