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

Objective: Uterine 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. Methods: Using 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. Results: Mean 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). Conclusions: Initial 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.