Referral patterns, cancer diagnoses, and waiting times after introduction of two week wait rule for breast cancer: prospective cohort study

doi:10.1136/bmj.39258.688553.55

BMJ 2007;335:288 (11 August), doi:10.1136/bmj.39258.688553.55 (published 13 July 2007)

Research

Referral patterns, cancer diagnoses, and waiting times after introduction of two week wait rule for breast cancer: prospective cohort study

Shelley Potter, clinical fellow¹, Sasi Govindarajulu, staff grade breast surgeon¹, Mike Shere, associate specialist breast physician¹, Fiona Braddon, clinical information systems manager², Geoffrey Curran, cancer analyst³, Rosemary Greenwood, medical statistician⁴, Ajay K Sahu, consultant surgeon¹, Simon J Cawthorn, consultant surgeon¹

¹ Breast Care Centre, Frenchay Hospital, Bristol BS16 1JE, ² Administration Building, Frenchay Hospital, ³ Southmead Hospital, Bristol, ⁴ Research and Development Unit, United Bristol Healthcare Trust, Bristol

Correspondence to: S J Cawthorn Simon.Cawthorn{at}nbt.nhs.uk

Objective To investigate the long term impact of the two weekwait rule for breast cancer on referral patterns, cancer diagnoses,and waiting times.

Design Prospective cohort study.

Setting A specialist breast clinic in a teaching hospital inBristol.

Participants All patients referred to breast clinic from primarycare between 1999 and 2005.

Main outcome measures Number, route, and outcome of referralsfrom primary care and waiting times for urgent and routine appointments.

Results The annual number of referrals increased by 9% overthe seven years from 3499 in 1999 to 3821 in 2005. Routine referralsdecreased by 24% (from 1748 to 1331), but two week wait referralsincreased by 42% (from 1751 to 2490) during this time. The percentageof patients diagnosed with cancer in the two week wait groupdecreased from 12.8% (224/1751) in 1999 to 7.7% (191/2490) in2005 (P<0.001), while the number of cancers detected in the"routine" group increased from 2.5% (43/1748) to 5.3% (70/1331)(P<0.001) over the same period. About 27% (70/261) of peoplewith cancer are currently referred in the non-urgent group.Waiting times for routine referrals have increased with time.

Conclusion The two week wait rule for breast cancer is failingpatients. The number of cancers detected in the two week waitpopulation is decreasing, and an unacceptable proportion isnow being referred via the routine route. If breast cancer servicesare to be improved, the two week wait rule should be reviewedurgently.

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This article has been cited by other articles:

Crawford, S M. (2007). Breast cancer experience has wider implications. BMJ 335: 361-361 [Full text]
Helm, E. J, Nash, E. (2007). Breast cancer growth rates favour abolition of rule. BMJ 335: 361-361 [Full text]
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Rapid Responses:

Read all Rapid Responses

Breast cancer referral waiting times: Andrew J Maville
bmj.com, 15 Jul 2007 [Full text]
What changed in 2003?: Emma P M Holcroft
bmj.com, 16 Jul 2007 [Full text]
Breast cancer referrals: two week wait for all patients.: Gordon C Wishart, et al.
bmj.com, 18 Jul 2007 [Full text]
Delay of Breast Cancer Referral: Jeannie Erskine
bmj.com, 20 Jul 2007 [Full text]
More questions than answers, but let's not scrap the urgent referral guidance: Richard D Neal
bmj.com, 20 Jul 2007 [Full text]
Equity and justice: should mammographic resources primarily be used for diagnosis or screening?: Hazel Thornton
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Two week referral rule: David P Jones
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Breast cancer growth rates favour abolition of two week wait: Emma J Helm, et al.
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Long live the 2 week wait: Rupert A Gude
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Does longer wait improve cancer outcomes?: Christian P Subbe
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