title: The management of women with breast symptoms referred to secondary care clinics in Sheffield: implications for improving local services.
abstract: Information was collected about 302 women referred for breast symptoms and seen in surgical outpatient or outreach clinics during one month at two hospitals in Sheffield. Three-quarters of the women (n = 244) were referred to specialist breast clinics, 22% (n = 70) were referred to general surgical clinics and 3% (n = 6) were referred to outreach clinics. The ages of the women ranged from 16 to 85 years with a mean and median age of 45 years. Some 200 women (66%) presented with a lump or lumpiness, 42 women (14%) presented with pain, 29 women (10%) had a skin and/or nipple problem, and the remaining 31 women (10%) were concerned about their family history or reported other symptoms. A total of 23 women (8%) were diagnosed as having cancer, 180 (60%) were diagnosed as having benign breast disease, and 99 (33%) were diagnosed as normal. Of the 23 women with cancer, 22 were over 40 years of age; 21 women presented with a lump, one presented with pain, and one presented with metastatic disease. The time required to reach a final clinical diagnosis varied from the same day as the clinic visit to 35 weeks, with a median time of 3 weeks. Surgeons assessed the appropriateness of GPs' referrals for 257 cases and judged that 122 (47%) could have been managed by a GP. The implications of the findings for the organisation of specialist outpatient clinics are discussed, and a categorisation of women as either urgent or routine cases is suggested.
authors.affiliation: Institute of General Practice and Primary Care, Sheffield, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Laver
authors.forename: M W
authors.initials: MW
authors.lastname: Reed
authors.forename: B J
authors.initials: BJ
authors.lastname: Harrison
authors.forename: P D
authors.initials: PD
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000175:diagnosis; D001943:Breast Neoplasms / Q000175:diagnosis*; D004739:England; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors