Managing the 2-week wait for breast patients.
BACKGROUND
Published data suggest that the 2-week wait system and triple assessment at one fast-track clinic visit is an out-dated method of capturing disease from a referral population. These studies report up to 32% of breast cancer coming from routine referrals. It has been recommended, therefore, that all breast referrals should be seen within 2 weeks. The sheer volume of referrals are likely to prevent this target being achieved. The aim of this study was to analyse the performance of our fast-track system.


METHODS
The Birmingham Heartlands and Solihull fast-track clinics were set up in 1999 with a prospective audit system. The data from this audit were retrospectively analysed and cross-referenced with the cancer data base to determine the referral origin of breast cancers from November 1999 to February 2005.


RESULTS
A total of 14,303 (fast-track, n = 6678; routine referral, n = 7625) patients were seen over a 5-year period. Overall, 1095 cancers (91.8% of the total) came from the fast-track clinics which had a pick-up rate of 16.4% compared with 98 cancers (8.2% of the total) and a pick-up rate of 1.3% for routine referrals (P < 0.001). The appropriateness of fast-track referral was also analysed which showed that 14.4% of cancers were detected if the referral criteria were met compared to 0.55% if they were inappropriate (P < 0.001).


CONCLUSIONS
The traditional fast-track, triple assessment breast clinic is an efficient and well-structured way of diagnosing disease. We recommend that the two system referral pattern should continue.
Singhal
Rishi
R
Breast Unit, Heart of England NHS Foundation Trust, Birmingham, UK. singhal_rishi@rediffmail.com
Marudanayagam
Ravi
R
Balasubramanian
B
B
Paterson
I S
IS
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D042241:Early Diagnosis; D004739:England; D005260:Female; D006801:Humans; D008485:Medical Audit; D012017:Referral and Consultation; D012189:Retrospective Studies; D014850:Waiting Lists