Has the breast cancer 'two week wait' guarantee for assessment made any difference?

Abstract

Aims: To determine the referral practice of GPs to a Fast Access Breast Clinic before and after the implementation of the 'two week wait' and to demonstrate the impact of this guarantee on the detection rate of breast cancer and access to the Breast Clinic.

Methods: A complete audit cycle was performed in a District General hospital (Eastbourne District General Hospital). The main outcome measures were detected breast cancer, clinical accuracy of the GPs and the waiting time for a Fast Access breast clinic.

Results: Prior to the implementation of the Government's Directive, the detection rate of breast cancer was 22% and all cancers were seen within 1 week of referral letter. The routine waiting time for non-urgent assessment was 4 weeks. The clinical accuracy of GP referrals was 42%. On the basis of the findings in the first part of the audit, guidelines were sent to the GPs to aid in their referrals to FABC, prior to the 1 April deadline. After the implementation the re-audit showed that the cancer detection rate had dropped to 19% and only 85% of patients were seen in 2 weeks. The routine wait for non-urgent assessment had gone up to a minimum of 8 weeks. The clinical accuracy had slightly increased to 49%.

Conclusion: With the transfer of power on deciding the urgency of referrals from the specialist to the GP, there has been a decline in the cancer detection rate and an increase in the waiting time for patients not deemed urgent by the GPs. The decision on the urgency of referral should be in the hands of the relevant specialist who individually can decide the best way to run their Fast Access Breast Clinics and thus achieve the government's guarantee of a maximum two week wait for patients suspected of having breast cancer.