BMJ  2007;335:361 (25 August), doi:10.1136/bmj.39311.512396.3A

Letters

Two week rule

Breast cancer experience has wider implications

The first 150 words of the full text of this article appear below.

The implications of the fast track referral policy for suspected breast cancer raise issues for the NHS that go beyond this disease.^{1 2} The existence of two queues for investigation defies the sensible observation that to manage multiple queues for a particular service is inefficient.³

Potter et al list the criteria by which general practitioners (GPs) are expected to identify patients for urgent attention.¹ Their paper shows that the sensitivity and specificity of this discriminant in real clinical practice are low. We do not know how many patients were inappropriately reassured by their GPs before being found to qualify for referral, but experience suggests that there will have been some. All this comes about because the capacity for specialist assessment of women with breast symptoms is inadequate; the real comparison is with those health systems that allow patients direct access to specialists whose workload is therefore unfiltered but which attain timely . . . [Full text of this article]

Airedale General Hospital, Keighley, West Yorkshire BD20 6TD

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