Postmenopausal bleeding: Association of initial place of care with stage at diagnosis for uterine cancer.

objectiveUterine cancer has no routine screening. Early diagnosis requires timely/appropriate evaluation of symptoms - most commonly postmenopausal bleeding (PMB). We examined initial place of care for PMB and its association with uterine cancer stage at diagnosis.

methodsUsing the Surveillance, Epidemiology and End Results-Medicare database with linked American Medical Association Physician Professional Data, we identified 15,443 patients aged ≥66 with uterine cancer who presented with PMB. Initial place of care was categorized as: office visit to an obstetrician/gynecologist, office visit to a physician of another specialty, or emergency department (ED) visit. Multivariable regressions were used to analyze the relationship between patient characteristics, initial place of care, and stage at diagnosis.

resultsMean age of patients in the sample was 74.5 and 83.1 % were non-Hispanic White. 61.0 %, 27.8 %, and 11.2 % of patients had their first PMB claim filed from an office visit to an obstetrician/gynecologist, an office visit to a physician of another specialty, and an ED visit, respectively. Their median (10th-to-90th percentile) duration from first PMB claim to uterine cancer diagnosis was 20 (0-134), 32 (6-169), and 14 (0-92) days, respectively (P < 0.001). Patients whose first PMB claim was from an ED visit were more likely to have advanced stage cancer (e.g., adjusted OR [95 % CI] for having distant stage = 1.44 [1.16-1.80] compared to obstetrician/gynecologist visits and 1.31 [1.04-1.66] compared to other physician visits).

conclusionsInitial place of care for PMB was associated with duration to diagnosis. Patients using ED as initial place of care tended to have more advanced uterine cancer.