Andrew Rut: Eleven Doctors Over Two Years Missed a Cancer Diagnosis
Andrew Rut, Strategic Consultant Life Sciences and Pharmacovigilance at Andrew Rut Ltd, shared a post on LinkedIn:
“Eleven doctors. Two years. Every one of them said perimenopause.
It was Hodgkin’s Lymphoma.
Jessica Toonkel’s account in the Wall Street Journal last week is difficult to read but important. A persistent itch dismissed as hormonal for two years. Pain when drinking alcohol attributed to acid reflux. Night sweats that fitted the perimenopause narrative perfectly. A 10-centimetre mass in her lung found only when chest pain finally triggered a CT scan.
For years, medicine barely acknowledged that women had distinct physiology. Clinical research didn’t mandate the inclusion of women until 1993. Conditions like PCOS, endometriosis, and menopause were poorly understood, underfunded, and often trivialised. We are still paying for that neglect.
But as Dr Anna Barbieri puts it in the article: ‘We are witnessing a massive pendulum swing of one type of ignorance to another.’ The welcome and overdue focus on perimenopause has created a new blind spot. ‘Hormonal’ has become a catch-all explanation for middle-aged women’s symptoms, and it is shutting down clinical curiosity at exactly the point where it should be sharpened.
Having managed women’s hormonal health throughout my career, I see this as two distinct problems, and medicine struggles with both.
First, we still don’t adequately understand diseases that only affect women. PCOS, endometriosis, and menopausal complications remain under-researched relative to their prevalence and impact. Women wait an average of 7 to 8 years for an endometriosis diagnosis. That is a scandal.
Second, we are remarkably poor at recognising how diseases that affect both men and women present differently in women. Heart disease is the classic example: women are more likely to present with fatigue, nausea, and jaw pain than with crushing chest pain, and they are more likely to be sent home from the Emergency Room with a misdiagnosis. Cancers like Hodgkin’s Lymphoma can present with symptoms that overlap perfectly with perimenopause, as this case shows.
These are not the same problem, but they share a common root. We still treat ‘women’s health’ as a niche specialism rather than as something that should inform every clinical encounter with a female patient.
Hormonal explanations are real and they matter. But they should frame the backdrop of the person’s health, not become a bucket diagnosis.”
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