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GPs pressured into making referrals for breast cancer

GPs are inappropriately referring under the two-week rule for suspected breast cancer because they are caving in to pressure from young women, suggests a major new study.

The researchers said GPs should offer reassurances to younger women, even those with a breast lump, and refer them non-urgently.

But some GPs have said referring the so-called worried-well under the two-week rule is a clinically valid service.

The audit of 27,000 referrals for suspected breast cancer in the year 2001/2 by the Association of Breast Surgeons revealed that the median age of referral was 42, in spite of most cases occurring over 65.

The audit showed one in three cancers was still being missed by GPs who referred them non-urgently, which echoes results from an audit by the group for the year before.

The results, from 47 of the 120 breast units around the UK, showed the greatest number of urgent referrals ­ over 10,000 ­ were in women between 35 and 49. And around 6,000 were under-35s.

This compared with some 3,000 urgent referrals for women aged 65 to 79, according to the results presented at a Royal Society of Medicine conference in London last week.

Study lead Mr Paul Sauven, consultant surgeon at the Broomfield Hospital in Chelmsford, Essex, told delegates most cancers were in women over 65. He said: 'My concern is the very large burden placed on breast units by reasonably well women.'

He told Pulse: 'We would like to encourage our GP colleagues to stick as far as possible to the agreed guidelines. We specifically asked [in the cancer referral guidelines] that women under 35 should not be referred as urgent cancer cases unless there is categorical evidence of a cancer.'

But Dr Joseph Spitzer, a GP in north London, said treating the worried-well in this situation was providing an important service to patients: 'As a GP it's wonderful. Everything these days comes through in 14 days ­ couldn't we have it in every specialty?'

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