Breast cancer victims wait longer for treatment despite new rules

A flagship government policy intended to speed the treatment of breast cancer has failed women by creating a two-tier service with unacceptable delays, researchers report today. The "two-week wait rule", introduced with a fanfare in April 1999, was supposed to ensure that every woman with suspected breast cancer would be seen by a specialist within 14 days of referral by a GP.

Britain had the highest death rate in Europe from breast cancer and the new policy was intended to signal the Labour administration's commitment to modernise the NHS.

But almost a decade later, the first long-term study of the policy has revealed an increase in patients whose diagnosis of breast cancer has been delayed.

Doctors at the Frenchay Breast Care Unit in Bristol say urgent referrals to the unit leapt by 42 per cent between 1999 and 2005 but the number of cancers diagnosed fell from 224 to 191.

Over the same period, non-urgent referrals to the unit fell by almost a quarter, but the number of women diagnosed with breast cancer among them rose from 43 to 70.

GPs have proved unable to distinguish between patients who require an urgent referral within two weeks and those who can be referred routinely where the wait is a month or more, the doctors say.

Guidelines spell out which women should be referred urgently, including those with a "discrete hard lump", skin or nipple distortion, or eczema-like skin changes. But younger women, or women with breast pain, may be referred non-urgently, yet still turn out to have cancer.

Writing in the British Medical Journal, the researchers say the big increase in urgent referrals (from 1,751 in 1999 to 2,490 in 2005) has led to overcrowded clinics but a reduction in the proportion diagnosed with cancer - from 12.8 per cent to 7.7 per cent. Meanwhile referrals to routine clinics have fallen, and cases of cancer among them have risen from 2.5 per cent to 5.3 per cent. More than one in four patients ultimately diagnosed with breast cancer was referred non-urgently, a situation the researchers describe as alarming.

"These patients are potentially being disadvantaged by longer clinic waits and delays in diagnosis as waiting times for routine referrals have increased in the face of increasing service demands." The number of patients referred urgently has "dramatically increased" yet more than 90 per cent do not have cancer.

Shelley Potter of Bristol Royal Infirmary, who led the study, said: "The problem is that we are getting some women who shouldn't be referred urgently and some who should be but aren't. The guidelines are unhelpful - they are not terribly accurate for diagnosing people with breast cancer."

She added: "It is a two-tier system that is unfair. Everyone should be seen quickly, ideally within two weeks. A delay may not make a difference clinically but it has a big psychological impact. Any woman finding a lump automatically assumes it is cancer. It is unacceptable to make them wait a long time for a diagnosis."

At the Frenchay centre, doctors are working to increase capacity and speed the rate at which women are seen. Dr Potter said nurses had been trained to do "triple assessments" of women with suspected cancer - the gold standard for detecting the disease - previously done by doctors. This involves a physical examination, a mammogram or ultrasound test and a biopsy.

A Department of Health spokesperson said: "We shouldn't forget that cancer services have changed beyond recognition in the last 10 years - over nine out of 10 cancer patients were treated within two months of an urgent GP referral."