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2022-RA-916-ESGO The Early Detection of vulval CAncer Through self-Examination (EDuCATE) study: What women and clinicians think
  1. Vanitha N Sivalingam1,
  2. Kajal K Tamber2,
  3. John Newsham3,
  4. Stephanie Ogden3,
  5. Ursula Winters4,
  6. Fiona M Walter5,
  7. Richard Edmondson2,
  8. Louise Gorman6 and
  9. Emma Crosbie2
  1. 1Division of Cancer Sciences, University of Manchester, Manchester, UK
  2. 2Faculty of Biology, Medicine and Health, Division of Cancer Sciences, University of Manchester, UK
  3. 3The Dermatology Centre, Salford Royal NHS FT, Manchester, UK
  4. 4Department of Colposcopy and Gynaecological Oncology, St Mary’s Hospital, Manchester, UK
  5. 5Wolfson Institute of Population Health, Queen Mary University of London, UK
  6. 6Health Services Research and Primary Care, Division of Population Health, University of Manchester, UK


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

Methodology Clinician questionnaires were completed at a British vulval conference. Patient questionnaires were distributed through online patient networks and clinics. Patient and clinician focus groups recruited through purposive sampling analysed thematically explored barriers and facilitators of self-examination(n=28).

Results All ninety-eight clinicians agreed that self-examination plays an important role in detecting sinister vulval changes in high-risk women. 87% recommended monthly self-examination and 81% provided one-to-one teaching.

455 patients(median age 58 years) with lichen sclerosus(69%), lichen planus(13%), vulval cancer(14%) and VIN(13%) participated. Clinic respondents(n=197) were older(median 65 years 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 vulval abnormalities. Face-to-face specialist teaching was regarded as the best way to learn self-examination; only 9% reporting receiving this.

Themes from focus groups were developed based on experience of vulval self-examination: facilitators (patients’ confidence and familiarity with their bodies, individualised teaching by clinicians, contributing to empowerment of self-management and allowing early detection of sinister changes), barriers: (poor health-care experiences, lack of awareness amongst patients, lack of confidence in self-examination and identifying abnormalities, embarrassment, distress at changing vulval anatomy, physical barriers to visualising the vulva).

Conclusion Patients and specialist vulval clinicians recognise that vulval self-examination is important in early detection of vulval cancer, but a lack of formal teaching impairs confidence in the identification of abnormalities. Healthcare professional-led education and support may facilitate patients to self-examine and manage their long-term vulval conditions.

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