A ground-breaking new womb cancer test could spare thousands of women pain, anxiety and trauma by reducing the need for more invasive diagnostic procedures. It’s a significant development, not only for people affected by womb cancer, but also for many more who experience non-cancerous abnormal bleeding.

Enduring painful and invasive procedures has long been considered par for the course for women in gynae healthcare. This test not only offers hope for quicker, earlier cancer diagnosis, but it’s also part of a long overdue effort to provide more palatable alternatives.

Currently thousands of women each year undergo a procedure called a hysteroscopy to investigate unexplained vaginal bleeding, which can be a key “red flag” symptom of womb cancer. However, patient advocates from the Campaign Against Painful Hysteroscopy (CAPH) have spent the last eight years highlighting that as many as one in four of these patients experience severe pain during and after the procedure.

Responding to a survey by the campaign group, some women described hysteroscopy – where a thin telescope is passed through the cervix to examine the womb – as “barbaric”, “traumatic” and “the most painful thing I have ever felt”. This can have huge implications, including deterring women from seeking healthcare in future.

“Women’s lives are too often put at risk when they refuse to return for further checks and treatment following painful procedures carried out in outpatients, without anaesthetic, instead of with adequate anaesthesia,” says Elaine Falkner, Chair of the Campaign Against Painful Hysteroscopy.

While this isn’t the case for everyone, campaigners have argued that all patients undergoing hysteroscopy should be warned about the risk of severe pain and offered a choice of pain relief options – rather than simply being advised to take over the counter painkillers beforehand, as women typically have been in the past. This kind of advice, while fine for some patients, has the potential to leave others feeling dismissed, ignored and overlooked – or even blaming themselves for not ‘coping’ well enough.

Fortunately, as a result of this patient advocacy, the Royal College of Obstetricians and Gynaecologists (RCOG) is currently drafting updated guidance for clinicians, stating that all pain relief options should be discussed, as well as the risks and benefits of each, to allow women to make a more informed choice about their treatment. But an effective, pain-free alternative would be even better, which is what makes this new test so promising.

Research published today in the Journal of Clinical Oncology found the WIDTM-qEC PCR test can reliably detect womb cancer from a vaginal or cervical swab sample – making it more accurate than the existing diagnostic tools, as well as less invasive.

“We need diagnostic tests that are more acceptable, less invasive and less painful. The evidence emerging from this research shows that this test may also be more specific for all women – regardless of factors like womb thickness or conditions like fibroids which are prevalent in some communities. Creating a test that is more effective for everyone is a huge bonus,” says Athena Lamnisos, Chief Executive of gynaecological cancer charity the Eve Appeal, which helped fund the research.

Womb cancer is the fourth most common cancer in women, and the most common of the five gynaecological cancers, with nearly 10,000 people diagnosed each year. Of these, 90 per cent of diagnoses are picked up following abnormal vaginal bleeding – meaning any bleeding between periods, after sex or after the menopause, or bleeding that is heavier than normal.

However, the majority of people who experience abnormal vaginal bleeding won’t have cancer – it’s also a symptom of many other, less life-threatening conditions, including cervical ectropion, fibroids, endometriosis, and vaginal atrophy. According to lead researcher Professor Martin Widschwendter, “post-menopausal women with abnormal bleeding have a one in 10 chance of having womb cancer; for pre-menopausal women the chance is as low as one in 200.”

Current procedure is for patients with abnormal vaginal bleeding to be offered a transvaginal ultrasound, where a probe is placed inside the vagina to look for signs of a thickened womb lining (endometrium), which can indicate womb cancer. If this is found, patients are then referred on for a hysteroscopy and biopsy to take a closer look.

But concerns about painful hysteroscopies aren’t the only issue here. While transvaginal ultrasounds are effective at detecting womb cancer in post-menopausal white women, they aren’t equally useful for everyone. In pre and perimenopausal women the thickness of the endometrium fluctuates throughout their menstrual cycle, and Black women have much higher rates of benign womb conditions like fibroids, which also cause the womb lining to thicken. This results in a higher number of false positives, meaning younger women and Black women are more likely to be referred on for hysteroscopy unnecessarily.

Using the new PCR test appears to significantly reduce those false positives, meaning people who have womb cancer can be diagnosed more quickly, and those who don’t have it can be given the all-clear without the need for further investigations. According to the research, just 14 per cent of healthy post-menopausal and 15 per cent of healthy pre-menopausal women would require a biopsy after a false positive WIDTM-qEC test, compared to 44 per cent of post-menopausal and almost half of pre-menopausal women following a transvaginal ultrasound.

“CAPH are always pleased to hear about advances in diagnostic procedures that will ultimately reduce invasive hysteroscopy, and we welcome all research taking place in this area,” Falkner says. “CAPH has worked with the RCOG and the British Society for Gynaecological Endoscopy to ensure all women have a choice of [pain relief options] for diagnostic hysteroscopy, but clearly developments in less invasive procedures would be a great advantage in reducing waiting times and anxiety.”

New clinical studies have already started, with more planned to further validate these results – including further testing on the effectiveness of the new test in Black women. While it will no doubt take time for the test to become available in practice, it’s another important step in the move to better consider women’s needs – and their pain – when designing their healthcare.

Similar shifts are occurring in cervical cancer screening, with pilot programmes exploring whether women who don’t attend traditional screening could instead take a vaginal swab in the comfort of their own home. The fact a vaginal swab can be used means there is also potential for this new womb cancer test to become a self-sampling test. After centuries of normalising women’s pain and discomfort, medicine is finally waking up to how damaging that can be to health outcomes. It’s very long overdue, but a cause for optimism nonetheless.

All rights reserved. © 2021 Associated Newspapers Limited.