Delays - Common & Upsetting
a quick diagnosis when breast cancer is suspected makes a big difference.
breast cancer version of Einstein's theory of relativity: From the
minute that you are told you need a biopsy until you receive the
results time changes. Each stress filled day that you wait is longer
than any day before or after. The minutes become hours and the days
seem like a eternity.
if you ultimately find out that you don't have breast cancer, those
days - or weeks - of anxiety will have changed your life. If you
are diagnosed with breast cancer, the time you waited may have changed
your treatment outlook.
in a study published in the April 15, 2002, issue of the journal
Cancer indicate that a delay of more than 20 weeks in diagnosing
asymptomatic breast cancer is associated with increasing tumor size
and increasing risk of lymph node metastases. The researchers found
that delays of greater than 20 weeks from an initial suspicious
screening to actual confirmation of the cancer were significant
for worsening prognosis.
the need for speed, in 1999 the UK government announced a 2-week
directive for breast cancer referral. The initiative was set up
so that women with suspected breast cancer would be able to see
a specialist within 2 weeks of an urgent referral from their general
practitioner (GP). The GP in the British healthcare system is what
American insurance companies call your Primary Care Physician. The
GP sees you for all complaints and makes referrals to specialists
published in the May 25th issue of the British Medical Journal
reported that the initiative may not be working the way it was planned.
Some women with breast cancer are waiting six times longer than
they should be for diagnosis and treatment. Some wait for up to
three months to see a specialist.
Jonathan Roberts is a consultant surgeon associated with King's
College Hospital in London. His unit is part of a government initiative
called the "Cancer Collaborative," which applies business
management principles to cancer care. To see if the 2-week initiative
was working, Roberts and his colleagues analysed information on
nearly 3,600 GP referrals to King's College Breast Clinic between
April 1999 and December 2000.
found that 665 - only 18.5% - were marked as urgent and the remainder
non-urgent. Remember, urgent means that a patient must be seen within
researchers found that 62 urgent patients and 49 non-urgent patients
were eventually found to have breast cancer, suggesting that the
distinction had little bearing on clinical outcome.
another letter in the same journal, Paul Sauven, honorary treasurer,
BASO (British Association of Surgical Oncology) Breast Group reported
12 358 referrals were received by 15 breast units. Only 3452 were
graded as urgent by the general practitioner. A total of 1121 cancers
were diagnosed, but 406 of these were not referred urgently (table).
is clear that the 2-week wait initiative is not working. We are
artificially creating a two-tier system when there is no need for
one," Roberts explained in an interview with Reuters. "Our
earlier work has shown anxiety was the same regardless of whether
patients were referred urgently or non-urgently," he added.
to Dr. John Toy, Cancer Research UK's medical director, "Even
best intentioned approaches to improving cancer patient outcomes
will fail if they are too simplistic or flawed in design. The King's
group is to be loudly applauded for finding ways of rapidly managing
all women with the worry of suspected breast cancer, which are not
dependent on finding extra money."
Morgan, chief executive of the charity Breakthrough Breast Cancer,
asked the question that lies at the heart of the matter, "If
some units can see all women referred in two weeks, then why not
Medical Journal 2002;324:1279.
Elsewhere on the Web:
delays 'put lives at risk'
Two week rule for cancer referrals
Updated July 8, 2009