An "alarming" number of women with breast cancer are having their access to specialist care delayed by a controversial Government target, experts have warned.
The Department of Health introduced the "two week wait” rule in 1999 for urgent cases of suspected breast cancer. It stipulated that these patients should wait a maximum of two weeks to see a consultant after their GP appointment.
But a major study by researchers at Frenchay Breast Care Centre in Bristol seems to have confirmed fears that GPs are often unable to judge which patients should be classed as urgent and see within two weeks and which should wait longer.
The number of breast cancer cases diagnosed in the two-week group of patients has been low and instead, clinics have been flooded with inappropriate referrals, the specialists write in the British Medical Journal.
Calls for re-evaluation of system
"As a result, waiting times for those patients deemed non-urgent by the general practitioner have significantly increased," prompting considerable criticism because up to a third of cancers are ultimately diagnosed from this group. "No survival benefit has been shown, and several authors have called for a re-evaluation of the system," they say.
The research involved cases between 1999 and 2005, during which time the overall number of referrals went up 9%. There were 24,999 referrals to the Bristol clinic during the study period, with GPs classifying each patient as being either "urgent" according to the rule or "routine." Patients met the urgent referral criteria if they had certain characteristics, such as a hard fixed or enlarging lump, bloody discharge from the nipple or skin distortion.
The study revealed that the number of routine referrals decreased by 24%, but two-week wait referrals increased by 42% over the period in question. Despite the changes in referral patterns, the total number of cancers remained constant.
However, while the number of patients referred under the two-week rule increased over the period, the percentage diagnosed with cancer "significantly decreased" from 12.8% to 7.7%. Conversely, the number of routine referrals fell, but the percentage of cancer cases in that group more than doubled to 5.3% in 2005.
'Failed' to meet goal
The authors said this showed that the rule had “failed to achieve its goal."
"The number of cancers detected in the two week wait population is decreasing, and an unacceptable proportion is now being referred via the routine route," the add, concluding: "If breast cancer services are to be improved, the two week wait rule should be reviewed urgently."
Liberal Democrat health spokesman, Norman Lamb, said: "This is shocking proof of a system that is well-intentioned but appears to be failing patients.
It is clearly critical that cancer patients are seen very quickly but the current system actually leaves many people excluded.”
Maggie Alexander, director of policy and campaigns at Breakthrough Breast Cancer, said: “In 2005, Breakthrough secured a Government promise that by 2008 everyone referred with breast problems will see a specialist within two weeks. Today’s research shows just how vital it is that this promise is kept.”