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Breast Ca referral rule may become pointless

The cancer tsar is backing a move away from the 'fatally flawed' urgent referral rule ­ Joanna Clarke-Jones reports

Cancer tsar Professor Mike Richards has backed a drive to make the urgent referral guidelines for breast cancer 'pointless' by setting up one-stop clinics to see all patients within two weeks.

The Government's national cancer services collaborative is running pilots in three areas where ­ by re-

organising existing resources ­ all suspected breast cancer patients are seen within a fortnight. This is regardless of a patient's 'urgency' status decided by GPs according to national guidelines.

Mr Tim Archer, consultant general surgeon at Ipswich Hospital, Suffolk, and joint breast cancer lead on the collaborative, said: 'Our aim is to get everyone seen within two weeks ­ and then we can dispense with the urgent referral rules.'

He hoped the pilots ­ which have improved detection rates in some

areas ­ would act as a catalyst to encourage other areas to set up similar clinics so the two-week rule eventually becomes 'pointless'.

Figures have shown over 40 per cent of women with breast cancer are referred through the non-urgent route ­ leading to waits of up to 17 weeks.

Professor Richards has backed the pilots, which involve specialists from the British Association of Surgical Oncologists and national charity Breakthrough Breast Cancer, saying: 'I welcome Breakthrough's partnership working with clinicians to enable all women who need specialist assessment to be seen within two weeks.'

Mr Archer said different areas would find different ways of dispensing with the two-week rule and costs could be kept low by reorganising existing resources.

For example, at his hospital's breast clinic patients are still referred by GPs according to statutory national guidelines but all patients are seen within two weeks using nurse specialists to triage and see pa-

tients with common breast problems.

Another pilot at Bristol's Frenchays Hospital offers training and a proforma on who to refer for GPs to use alongside national guidelines. All patients are seen within two weeks at a one-stop clinic.

A third pilot is running at King's College Hospital along similar lines.

Mr Archer said the advantages of the pilots were that they ended the 'uncertainty and anguish' of patients referred non-urgently and that patients were no longer 'disenfranchised'. He highlighted a wide variation across the country in 'cancer hit rates' from GP referrals.

In the pilot areas detection rates ranged from one in seven in Bristol to one in 24 at King's College. He said this was largely unexplained but GP education helped and deprived inner-city areas tended to have lower hit rates. The pilots would have no impact on this situation, he added.

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