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. 2007 Aug 11;335(7614):288.
doi: 10.1136/bmj.39258.688553.55. Epub 2007 Jul 13.

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

Shelley Potter  1 , Sasi Govindarajulu, Mike Shere, Fiona Braddon, Geoffrey Curran, Rosemary Greenwood, Ajay K Sahu, Simon J Cawthorn
Affiliations

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

Shelley Potter et al. BMJ. .

Abstract

Objective: To investigate the long term impact of the two week wait 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 in Bristol.

Participants: All patients referred to breast clinic from primary care between 1999 and 2005.

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

Results: The annual number of referrals increased by 9% over the seven years from 3499 in 1999 to 3821 in 2005. Routine referrals decreased by 24% (from 1748 to 1331), but two week wait referrals increased by 42% (from 1751 to 2490) during this time. The percentage of patients diagnosed with cancer in the two week wait group decreased from 12.8% (224/1751) in 1999 to 7.7% (191/2490) in 2005 (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 people with 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 failing patients. The number of cancers detected in the two week wait population is decreasing, and an unacceptable proportion is now being referred via the routine route. If breast cancer services are to be improved, the two week wait rule should be reviewed urgently.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Trends in referral patterns from primary care to breast clinic, 1999-2005
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Fig 2 Cancers diagnosed in patients referred from primary care, 1999-2005. Overall number of cancers referred has remained constant. The number of cancers diagnosed from the two week wait group has decreased with time, despite increasing numbers of referrals, while number of cancers referred as “routine” has increased over same period
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Fig 3 Percentage of referrals with diagnosis of cancer by referral group. Percentage of two week wait referrals diagnosed with cancer has declined despite increasing numbers of referrals. Reverse is true of routine referrals, suggesting decreased diagnostic accuracy in primary care
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Fig 4 Waiting times for appointments. Increasing numbers of two week waits have affected clinic capacity, increasing waiting times for routine referrals. Decrease in waiting times for routine referrals seen from 2000 to 2002 was caused by increased clinic capacity created by change in follow-up policy
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