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Audit of two week wait for breast cancer in Birmingham NHS Foundation Trust

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Audit of two week wait for breast cancer in Birmingham NHS Foundation Trust Introduction. Breast cancer is the commonest malignancy to affect women with approximately 32,000 new cases per annum in England and Wales. The maximum 2-week wait for breast cancer referral was introduced by the UK Government on 1 April 1999 in an attempt to improve outcomes for patients with breast cancer. The resultant fast track or two week wait rule stipulated that all patients with suspected breast cancer should be seen by a specialist within two weeks of urgent referral by a general practitioner thus facilitating early diagnosis and treatment. Criteria for urgent two week wait referral of patients with suspected breast cancer include: * Patients of any age with a discrete hard lumps with fixation, with or without skin tethering, females aged > 30 years with discrete lump persisting after period/menopause, males aged > 50 ...read more.


All patients who were referred to the Birmingham Heartlands and Solihull fast-track breast clinics were included. The data were collected from November 1999 to February 2005. The data collected in this audit included mode of referral (routine versus fast-track) and appropriateness of the referral (adherence to the referral criteria). These data were retrospectively analysed and cross-referenced with the cancer data base to obtain the subsequent diagnosis (cancer versus non-cancer). Audit data were examined on waiting times, the number of urgent and routine referrals, the use of referral criteria and outcome of patients referred from primary care (number of cancers subsequently diagnosed) in urgent and non-urgent stream. Results. A total of 14,303 patients were seen over a 5-year period. Out of these, 46.7% (n = 6678) of the referrals originated from urgent fast-track and the remainder 53.3% (n = 7625) ...read more.


So, in effect, they should have been fast-track patients if the referring GP had stuck rigidly to the referral criteria. The accuracy of GP referrals was shown to be improving with time (69.9% in 2003, 71.1% in 2004 and 72.1% in 2005) and thus was only a reflection of learning curve problems. Conclusion. This audit of two week wait for breast cancer showed that Birmingham breast clinics complied with the national guidelines and all women referred urgently by their GPs with suspected breast cancer saw a specialist within a fortnight. The cancer detection rate among two week wait referrals was high and the percentage of breast cancers diagnosed outside the 2-week referral route was not significant. The audit provides evidence that urgent two week referrals are efficient in identifying patients with breast cancer. Reference: Singhal R., Marudanayagam R., Balasubramaniam B., Paterson I. (2008). Managing the 2-week wait for breast patients Ann R Coll Surg Engl 90(1): 69-71. ...read more.

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