BMJ  2007;335:361 (25 August), doi:10.1136/bmj.39311.468183.3A

Letters

Two week rule

Breast cancer growth rates favour abolition of rule

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

Potter et al highlight the failure of the two week wait initiative to discriminate between patients with breast cancer and those with benign disease.¹

However, what is more important is whether earlier diagnosis provided by a fast track system improves outcomes for patients. Evidence for this is lacking. This is likely to be due to the underlying biology and kinetics of tumour growth. Most breast cancers are relatively slow growing, with an average tumour volume doubling time of 280 days. Assuming that each cancer develops from a single cell and assuming a constant doubling time of 280 days, a tumour of 2 mm (the lowest mammographically detectable level) will have been present for more than 18 years.² A clinically detectable tumour will have been present for even longer.

Moreover, the development of metastases, which ultimately affects the potential for curative treatment, is likely to have occurred even before the primary . . . [Full text of this article]

¹ Bristol Royal Infirmary, Bristol BS1 3NU, ² Southmead Hospital, Bristol BS10 5NB

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