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Breast Ca referral rules 'unworkable'

More than four in 10 women with breast cancer are being referred non-urgently, official statistics reveal.

The finding has prompted a key Government adviser to warn that the national two-week referral guidelines are unworkable.

GPs are supposed to use the guidelines, published by the National Institute for Clinical Excellence, to discriminate between women with suspected cancer who must be referred urgently and those with benign breast problems who can be seen routinely.

But a claim from public health minister Melanie Johnson that the two-week deadline has been a great success was undermined by figures showing only 58 per cent of women diagnosed with breast cancer in England in the year to April had been referred urgently.

According to national charity Breakthrough Breast Cancer this meant 10,000 women with the disease were left facing waits of up to 17 weeks for a routine appointment.

Mr Clive Griffith, national breast cancer lead for the Government's Cancer Services Collaborative, said it was inevitable GPs would miss early cases of breast cancer because the urgent referral guidelines focused heavily on signs of 'fairly advanced disease'.

Mr Griffith, consultant surgeon at Royal Victoria Infirmary in Newcastle, called for a network of nurse specialist clinics to be established so the two-track referral system could be abolished and every woman seen within two weeks.

He said fears among specialists that breast clinics would be overwhelmed under such a system had proved unfounded in pilots.

He added: 'It depends on good communication with GPs so they are not sending women with cyclical pain, or younger women for whom the risks are smaller.'

Dr Rob Bailey, a GP in Peterborough who helped write the national referral guidelines, agreed it was very difficult for GPs to distinguish urgent from non-urgent cases, adding: 'It is a cause for concern. We should be looking to improve.'

He said: 'My message to GPs is if you have any doubt refer urgently. Perhaps our level of suspicion needs to be a bit higher, particularly in older women.'

In a survey of 105 GPs conducted by Breakthrough, 42 per cent said they found it very difficult to distinguish between urgent and routine breast symptoms and 35 per cent said they did not use any referral guidelines.

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