‘I’m either going through the menopause, or I’ve got cervical cancer’ – how do women make sense of bodily changes that could (but probably don’t) signal cancer?Jo Waller7 July 2015
The recent cervical screening awareness week was a great opportunity to share information about cervical screening. Screening (the ‘smear test’) aims to pick up and treat abnormal cells in the cervix before they become cancer. But for most gynaecological cancers, there isn’t a screening programme, so noticing symptoms and getting them checked is the key to making sure cancer can be diagnosed at an early stage when treatment is most effective.
Our newly published research paper tried to understand how women notice and make sense of symptoms that might indicate a gynae cancer. There are five of these cancers, affecting the cervix, womb, ovary, vagina and vulva. They have a range of symptoms, many of which are common and are caused by much less serious conditions – things like bloating, bleeding between periods or after sex, and changes in bowel habits. We interviewed 26 women who’d had these kinds of symptoms to find out what they thought had caused them, and what they’d done about them. Generally, and understandably, most women assumed that the symptoms were caused by everyday things like diet, the contraceptive pill, menopause or pre-existing conditions like fibroids. We didn’t mention cancer in the interviews, and nor did most of the women taking part. One participant whose periods had become longer than usual said: ‘I have a contraceptive implant which can cause irregular bleeding … It never caused me any trouble and suddenly all this. So that could be one of the reasons.’
Most women in our study tried to manage the symptoms themselves, or talked to friends or family about them, rather than going to the doctor. They only tended to see their GP if the symptoms got worse or became persistent.
Our study highlights the essential conundrum of cancer symptoms, which is that the symptoms that indicate cancer are often quite common, and in most cases will be have a much less serious explanation. But if we ignore them completely, or until they become debilitating, we risk diagnosing cancer at a later stage when treatment might be more aggressive and less effective. The difficult thing is finding the balance between rushing to the doctor for every twinge, and leaving it too late when something is really wrong.
Cancer Research UK have developed guidelines to help people decide when it’s appropriate to go to the doctor and get a symptom checked out. For example, with bloating, they suggest you make an appointment if you’ve been bloated on most days for at least 3 weeks. This should be useful for people worrying about whether their symptom is serious enough to warrant ‘bothering’ their GP, which is sometimes a barrier to making an appointment.
Our research group is continuing to do work to try to understand how people make sense of symptoms, and the processes through which they decide if and when to seek help. If you do work in this area, you might be interested in this funding call for early diagnosis research. And if you have comments on our study, we’d love to hear them.