Breast cancer victims 'still face critical delays'

Women with breast cancer are still facing unacceptable delays before they see a specialist doctor because government reforms have created a two-tier service, consultants will warn today.

In a drive to speed up cancer treatment, the Department of Health has ordered that all patients with suspected cancer should be able to see a specialist within two weeks of their GPs deciding they are urgent cases.

But in a letter to the British Medical Journal, a team of surgeons at King's College Hospital, London, says the emphasis on urgent referrals has meant longer, and potentially life-threatening, delays for other patients. In some areas, women are waiting more than 12 weeks for diagnosis and treatment – or six times longer than the supposed limit for urgent referrals.

The surgeons say all patients at the King's College Hospital breast cancer unit are seen within two weeks, regardless of their grading. But an examination of all GP referrals to the clinic between April 1999 and December 2000 showed GPs were failing to assess urgency correctly.

Of the 3,597 referrals made, 665 were graded as urgent and 2,939 as non-urgent. Of these, 62 urgent patients and 49 non-urgent patients were found to have breast cancer.

The letter, signed by Jonathan Roberts and David Scott-Coombes, who are both consultant surgeons, says: "The emphasis on seeing urgent cases within the time has been at the expense of the non-urgent cases. Waiting times have increased to 12 weeks in some units."

They add: "By grading patient referrals, we are creating a two-tier structure, with patients in the non-urgent group waiting longer periods for diagnosis and treatment. For patients with cancers in this group the delay can be critical."

The surgeons welcome the Government's drive to speed up treatment but say it has meant "unacceptable delays to some patients with breast cancer as well as delay with anxiety to those without". Dr John Toy, the medical director of Cancer Research UK, said the two-week directive might have been well-intentioned, but it appeared to have been "too simplistic" in practice.

The department said about 95 per cent of urgently-referred patients were now seen within two weeks. There were 500 units in the country, including King's College Hospital, where GPs and consultants were working closely together.

A spokeswoman said: "Clearly, it is important that the right people are urgently referred. GPs have guidelines to help them to decide who needs to be urgently referred, those patients that can be referred for a routine appointment and those who can be monitored at primary care level."