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EPV284/#238 The early detection of vulvar cancer through self-examination (educate) study: what women and clinicians think
  1. VN Sivalingam1,
  2. K Tamber1,
  3. J Newsham2,
  4. S Ogden2,
  5. U Winters3,
  6. FM Walter4,5,
  7. RJ Edmondson1 and
  8. EJ Crosbie1
  1. 1University of Manchester, Division of Cancer Sciences, School of Medical Sciences, Manchester, UK
  2. 2Salford Royal NHS Foundation Trust, The Dermatology Centre, Manchester, UK
  3. 3Manchester University Hospitals NHS Foundation Trust, Colposcopy and Gynaecological Oncology, Manchester, UK
  4. 4University of Cambridge, Department of Public Health and Primary Care, Cambridge, UK
  5. 5Queen Mary University of London, Institute of Population Health Sciences, London, UK


Objectives Rates of vulvar cancer are increasing globally. Early detection reduces surgical morbidity and prolongs survival. Although population screening has no role, vulvar self-examination may prompt early diagnosis in high-risk women. UK guidance promotes self-examination in women with high-risk vulvar conditions, but there is a lack of evidence about current practice, acceptability and barriers to vulvar self-examination.

Methods Clinician questionnaires were completed at a UK vulvar conference. Patient questionnaires (incorporating vulvar self-examination and cancer awareness) were distributed through patient networks and clinics.

Results All ninety-eight clinicians agreed that self-examination plays an important role in detecting sinister vulvar changes in high-risk women. 87% recommended monthly self-examination and 81% provided one-to-one teaching despite believing that few patients practised self-examination. 455 patients (median age 58 years) with lichen sclerosus(69%), lichen planus(13%), vulvar cancer(14%) and VIN(13%) participated. Clinic respondents(n=197) were older(median 65 vs 52 years, p<0.001) and 65% reported self-examining compared with 86% of online respondents(p<0.001). Despite regular self-examination, 40% were not confident about recognising vulvar abnormalities. Lack of awareness(38%), confidence(31%) and physical difficulties visualising the vulva(32%) were top barriers to self-examination. Face-to-face specialist teaching was regarded as the best way to learn self-examination but only 9% of patients reported receiving this. Patients agreed that a magnified, extendable mirror and photographs depicting sinister changes would aid self-examination.

Conclusions Patients and clinicians recognise that vulvar self-examination is important in early detection of cancer, but a lack of formal teaching impairs confidence in the identification of abnormalities. Visual aids may facilitate self-examination but should be reinforced by education and support.

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