University of Queensland's SAFE Score: A Game-Changer for Early Detection

A groundbreaking five-minute questionnaire known as the Simplified Adolescent Factors for Endometriosis (SAFE) score is set to revolutionize how endometriosis is identified in Australia. Developed by researchers at the University of Queensland (UQ), this simple tool promises to slash the typical six-to-eight-year diagnostic delay that plagues thousands of women, enabling faster referrals to specialists and earlier intervention.

Endometriosis, a chronic condition where tissue similar to the uterine lining grows outside the uterus, affects up to 11 percent of Australian women of reproductive age—equating to around one in nine. Symptoms like severe pelvic pain, heavy menstrual bleeding, and fatigue often go unrecognized or dismissed, leading to profound impacts on quality of life, fertility, and mental health. UQ's innovation, rooted in decades of longitudinal data, positions the university at the forefront of women's health research in higher education.

The SAFE score emerged from the Australian Longitudinal Study on Women’s Health (ALSWH), a flagship UQ-led project tracking thousands of Australian women over decades. This collaboration underscores how university-driven cohort studies drive real-world health solutions.

The Hidden Toll of Endometriosis on Australian Women

In Australia, endometriosis imposes a staggering economic burden estimated at $7.4 to $9.7 billion annually, with the majority stemming from productivity losses rather than direct medical costs. Women endure an average wait of six to eight years for diagnosis, often navigating misdiagnoses, normalized menstrual pain, and fragmented care. By age 44-49, about one in seven women born in the 1970s have received a diagnosis, but many more suffer undiagnosed.

Hospitalizations for endometriosis-related issues number in the tens of thousands yearly, compounded by comorbidities like depression, irritable bowel syndrome, and infertility. University research, such as UQ's, highlights how early detection could mitigate these cascading effects, preserving workforce participation and family planning. For higher education, this translates to growing demand for experts in public health, epidemiology, and gynecology.

How the SAFE Score Works: A Step-by-Step Guide

The SAFE score is a points-based questionnaire comprising just six targeted questions, taking only five minutes to complete in a GP consult. It assesses key risk factors identified through rigorous analysis:

• Do you often experience pelvic pain?
• Have you sought treatment for pelvic pain?
• Have you taken painkillers for pelvic pain?
• Do you have heavy menstrual bleeding or painful periods?
• Is there a family history of endometriosis? (Two questions adapted for age.)

A score of two or more flags high risk, prompting specialist referral. Its high negative predictive value (around 90-95 percent) means low scores confidently rule out the need for immediate escalation, easing GP workloads.

Designed for adolescents and adaptable across ages, it empowers primary care to act swiftly, bridging the gap to ultrasound, MRI, or laparoscopy—the current gold standard, often invasive and delayed.

Research Excellence at UQ's Australian Women and Girls' Health Research Centre

At the helm is Professor Gita Mishra AO, Director of UQ’s Australian Women and Girls' Health Research Centre and NHMRC Leadership Fellow. Her team leveraged ALSWH data from over 9,000 women across cohorts born 1973-78 and 1989-95, employing logistic regression and bootstrapping for robust risk factor selection. Published in eClinicalMedicine (The Lancet), the study boasts an area under the curve (AUC) of 0.71-0.79, with sensitivity 47-64 percent and specificity 82-86 percent at the optimal cut-point.

Funding from the Medical Research Future Fund (MRFF) and NHMRC highlights federal investment in university research. "By detecting endometriosis earlier—ideally in adolescents—we hope to reduce the average delay," Prof. Mishra noted. This centre exemplifies how Australian universities foster interdisciplinary teams in public health, statistics, and clinical gynecology.

For aspiring researchers, UQ offers PhD opportunities in longitudinal studies via higher-ed-jobs/postdoc, aligning with Australia's push for women's health expertise.

Photo by David Zhang on Unsplash

Validation and Performance: From Data to Clinic

The SAFE score was internally and externally validated across ALSWH subsets, demonstrating consistency despite cohort differences (11 percent prevalence in younger vs. 16 percent in older). Its simplicity—no labs required—makes it ideal for resource-limited settings. Upcoming Brisbane trials in GP, endometriosis, and pelvic pain clinics will assess real-world utility, potentially via a user-friendly app.

Compared to prior tools, SAFE prioritizes adolescent factors, addressing a critical gap where symptoms often start at menarche but diagnosis lags until fertility concerns arise in the late 20s.

Empowering GPs and Transforming Primary Care

The Royal Australian College of General Practitioners (RACGP) welcomes SAFE as a practical aid for busy clinics. Age-appropriate questions target teens, where normalization of pain delays help-seeking. By fast-tracking high-risk cases, it reduces unnecessary referrals while ensuring equitable access, particularly in rural Australia.

Integration into electronic health records could amplify impact, supported by UQ's digital health innovations. Check career advice for research assistants in such translational projects.

Real Stories: Women Advocating for Change

Brisbane mother Amy Wilson endured seven years of fatigue, pelvic inflammation, anxiety, and depression before her stage-four diagnosis at 41, requiring surgery to remove bowel-adjacent tissue and fallopian tubes. "I don’t want my daughters to suffer the same," she shared. SAFE could have flagged her risks earlier, altering her trajectory.

Stakeholders like Endometriosis Australia praise university-led advances, urging nationwide rollout amid federal budget boosts for 11 new clinics.

Future Outlook: Trials, Apps, and National Adoption

Phase one trials commence soon, evaluating feasibility and referral accuracy. Success could lead to RACGP endorsement and PBS integration. UQ explores app development for self-screening, enhancing telehealth in remote areas. Long-term, it supports non-invasive diagnostics like advanced imaging, reducing laparoscopy reliance.

Government initiatives, including MRFF funding, signal momentum. Universities like UQ drive this via Australian academic jobs.

Photo by Vlad Kutepov on Unsplash

University Research Driving Women's Health Innovation

ALSWH, UQ's cornerstone since 1996, exemplifies longitudinal research's power, informing policies on menopause, fertility, and chronic disease. Complementary efforts at Adelaide University (AI diagnostics) and Hudson Institute (biomarkers) highlight Australia's higher ed ecosystem.

Prof. Mishra's NHMRC fellowship underscores career paths: from PhDs in epidemiology to leadership roles. Explore professor jobs or lecturer positions in women's health.

Careers in Endometriosis and Women's Health Research

Australia's research surge creates opportunities: postdocs in cohort studies, research assistants in trials, faculty in public health. UQ's centre seeks talent for GELLES substudy expansions. With $793m federal women's health package, demand grows for epidemiologists, data scientists, and clinicians.

Rate professors like Gita Mishra on Rate My Professor. Visit higher-ed-jobs, university jobs, and career advice for roles. Post openings at recruitment.

In summary, UQ's SAFE score exemplifies higher education's role in tackling endometriosis, promising faster diagnoses, better lives, and thriving research careers. Stay informed via Australian jobs.