HSE examining extent of delayed diagnosis of endometrial cancer

The HSE’s Chief Clinical Officer has commissioned work to determine “the extent to which and if delayed diagnosis of endometrial cancer is prevalent in other hospitals” after failings identified in an external review of gynaecology services at Letterkenny University Hospital (LUH).

A HSE spokesperson told the Medical Independent that “this work is ongoing”.

An external review into LUH’s gynaecology service was commissioned by Saolta University Health Care Group in response to eight instances of delayed diagnosis in women with endometrial cancer. The review, which was presented to Saolta in May 2020, had a particular focus on post-menopausal bleeding pathways.

The review referred to “suboptimal triage and administrative practices, suboptimal follow-up practices, and limited fail safes, underpinned by ineffective communication” as factors in delayed diagnoses.

In July 2020, in an addendum to the review, the external team expressed dissatisfaction that LUH and Saolta did not inform them that a histology audit was occurring in parallel, which examined endometrial cancers diagnosed at LUH between 2010 and 2019.

This audit referred to 133 women diagnosed with endometrial cancer and 38 women waiting longer than 100 days from initial referral to diagnosis. Correspondence from Saolta stated that 25 of the women had a delay in diagnosis with a potentially serious consequence.

The review authors stated that consideration must be given to whether issues at LUH were replicated in other hospitals.

The review also highlighted the absence of national standards for women who present with post-menopausal bleeding, with no clear timelines for assessment, investigation, and treatment on presentation.

Interim national clinical guidance on the timeframe for investigation was developed by the National Women and Infants Health Programme in August 2020. The Programme is currently leading on the development of a new national clinical guideline