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Two-week rule 'a failure'

The two-week referral rule is failing cancer patients referred through both the fast-track and the routine pathways, a damning new analysis has revealed.

The study, published in the BMJ, found that two-week referrals for breast cancer increased by 42% between 1999 and 2005, and routine referrals also increased by 24% within the same time frame.

But despite the dramatic increase in the number of two-week referrals, the proportion of patients diagnosed with cancer in this group fell from 12.8% to 7.7%. Meanwhile the proportion of non-urgent referrals diagnosed with cancer rose from 2.5% to 5.3%.

The researchers also showed that although waiting times for fast-track referrals had stayed within targets, waiting times for routine appointments had increased since 2003 – with the average wait now 30 days. The study reinforces claims by secondary care researchers that urgent referrals made by GPs in line with NICE recommendations are swamping the system so that both urgent and routine cases are facing delays in diagnosis (see left).

Study leader Mr Simon Cawthorn, consultant surgeon at the Frenchay Hospital in Bristol, said: 'The two-week rule was meant to improve access to specialist services for all patients with suspected breast cancer. It has failed to achieve that goal.'

Dr Rob Bailey, a GP and hospital practitioner in breast cancer in Peterborough, Cambridgeshire, said the study confirmed it was difficult for GPs to decide whether or not a breast lump was malignant.

Two-week referral chaos

• February 2007 – two studies show the rule is 'overwhelming' hospitals with inappropriate referrals and failing to identify colorectal cancers effectively

• March 2007 – study reveals 'marked variability' in GPs' use of referral guidelines for colorectal cancer, with many apparently unaware of the two-week rule

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