One stop breast clinics—victims of their own success?A prospective audit of referrals to a specialist breast clinic

Rs, Patel; Smith, Daniel; Reid, I.

doi:10.1053/ejso.1999.0920

Cited by 34 publications

(30 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our malignancy pick-up rate of 17.3% was, however, similar to that found in another series from Greece (Vassilakopoulos and Pangalis, 2000). Other solid tumour one-stop clinics reported malignancy pick-up rates of 3 -10% (Gui et al, 1995;Berry et al, 1998;Toomey et al, 1998;Lamah et al, 2000;Patel et al, 2000). Of note, relative to other lymphomas, a higher than anticipated incidence of Hodgkin's disease was seen in our series.…”

Section: Discussionsupporting

confidence: 88%

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

et al. 2003

View full text Add to dashboard Cite

Lymphadenopathy is common, affecting patients of all ages. The current referral pattern for investigating patients with lymphadenopathy varies widely with no universally practised pathway. Our institution set up a lymph node diagnostic clinic (LNDC) accepting direct referrals from primary care physicians. Details of clinical presentation and investigations were recorded prospectively. Between December 1996 and July 2001, 550 patients were referred (M: 203; F:347). The median age was 40 years (range 14 -90). The median time between initial referral and the first clinic visit was 6 days. Of 95 patients diagnosed to have malignant diseases, the median time from the first clinic visit to reaching malignant diagnosis was 15 days. Multivariate logistic regression analysis identified five significant predictors for malignant nodes: male gender (risk ratio (RR) ¼ 2.72; 95% confidence interval (CI): 1.63 -4.56), increasing age (RR ¼ 1.05; 95% CI: 1.04 -1.07), white ethnicity (RR ¼ 3.01; 95% CI: 1.19 -7.6) and sites of lymph nodes: supraclavicular region (RR ¼ 3.72; 95% CI: 1.52 -9.12) and X2 regions of lymph nodes (RR ¼ 6.41; 95% CI: 2.82 -14.58). Ultrasound and fine-needle aspiration cytology of palpable lymph nodes were performed in 154 and 289 patients, respectively. An accuracy of 97 and 84% was found, respectively. In conclusion, a multidisciplinary lymph node diagnostic clinic enables a rapid, concerted approach to a common medical problem and patients with malignant diseases were diagnosed in a timely fashion.

show abstract

Section: Discussionsupporting

confidence: 88%

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

et al. 2003

View full text Add to dashboard Cite

show abstract

“…27 Comparison with existing literature A total of 7% of patients in the derivation cohort who were referred were found to have breast cancer, a figure similar to that given in two other UK studies of patients in breast care clinics who were referred. 12,13 This enhances the external validity of this study's findings. 20,21 In a US breast care clinic, breast cancer occurred in 22.8% of women who were referred; this higher figure probably reflects the differing referral and access patterns between healthcare systems in the UK and the US.…”

Section: Explanatory Variable Number Of Patients Number With Cancer (%)supporting

confidence: 52%

“…12,13 This enhances the external validity of this study 's findings. 20,21 In a US breast care clinic, breast cancer occurred in 22.8% of women who were referred; this higher figure probably reflects the differing referral and access patterns between healthcare systems in the UK and the US.…”

supporting

confidence: 52%

“…12 Furthermore, over a third of referrals are deemed to be inappropriate and large differences in GP referral patterns persist. 13,[14][15][16][17][18][19] This poor performance of breast cancer referral guidance is attributed to the limited diagnostic value of the clinical criteria on which the guidelines are based. 12 Clinical prediction rules are clinical tools that quantify the contribution of the history, physical examination, and diagnostic tests, and stratify patients according to the probability of having a target disorder.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Identifying suspected breast cancer: development and validation of a clinical prediction rule

McCowan¹,

Donnan²,

Dewar³

et al. 2011

Br J Gen Pract

View full text Add to dashboard Cite

BackgroundAn evidence-based approach is needed to identify women with breast symptoms who are most likely to have breast cancer so that timely and appropriate referral can take place. AimTo report the development and validation of a clinical prediction rule for the diagnosis of breast cancer. Design and settingCohort study with two prospective groups of women: those presenting to a symptomatic breast clinic (derivation cohort) and a separate cohort presenting to 11 general practices (validation cohort) in Tayside, Scotland. MethodRegression analysis was used to derive a clinical prediction rule from presenting symptoms, personal and family history, and clinical findings. Validation consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. ResultsIn the derivation cohort of 802 patients, 59 (7%) were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] = 1.07 to 1.13); presence of a discrete lump (AOR 15.20, 95% CI = 4.88 to 47.34); breast thickening (AOR 7.64, 95% CI = 2.23 to 26.11); lymphadenopathy (AOR 3.63, 95% CI = 1.33 to 9.92); and lump ≥2 cm (AOR 5.41, 95% CI = 2.36 to 12.38). All eight patients with skin tethering had breast cancer. The regression model had good predictive power, identifying all five breast cancers in the validation cohort of 97 patients in the top two deciles of risk. ConclusionThe clinical prediction rule discriminates between patients at high risk of breast cancer from those at low risk, and can be implemented as an evidence-based recommendation to enhance appropriate referral from general practice to a symptomatic breast clinic. Ongoing validation in further populations is required.Keywords breast cancer; diagnosis; primary care. methodological standards. Conventionally, clinical prediction rules go through three distinct stages before full implementation in a clinical setting:1. Development of the clinical prediction rule, establishing the independent and combined effect of explanatory variables that can include symptoms, signs, or diagnostic tests.2. Narrow and broad validation: the explanatory variables or clinical predictors in the derivation clinical prediction rule set are assessed in separate populations.3. Impact analysis of the clinical prediction rule, assessed by means of a randomised controlled trial: the impact of applying the clinical prediction rule in a clinical setting is measured either by patient outcome, health-professional behaviour, resource use, or any combination of these outcomes. 21The aim of this study was to develop and validate a clinical prediction rule in women presenting with breast symptoms, so that a more evidence-based approach to referral -which would include urgent referral under the 2-week rule -could be implemented as part of clinical-practice guidance. METHOD Study design and participantsThe study comprised two cohorts of p...

show abstract

“…However, breast clinics have been concerned for some time about increasing numbers of referrals from GPs (Patel et al, 2000). The predictive value of symptoms is poorly defined in general practice , and only 9 -10% of referrals are subsequently found to have breast cancer (Patel et al, 2000;Sauven, 2001).…”

mentioning

confidence: 99%

Effect of the UK government's 2-week target on waiting times in women with breast cancer in southeast England

et al. 2003

View full text Add to dashboard Cite

A government target of a maximum 2-week wait for women referred urgently with suspected breast cancer was introduced in April 1999. We have assessed changes in the distributions of waiting times and the proportions of cases meeting proposed targets before and after this date, using clinical audit data on 5750 women attending 19 hospitals in southeast England during the period July 1997 -December 2000, who were subsequently found to have breast cancer. The proportion of cases being seen within 2 weeks of referral rose from 66.0 to 75.2%, and the median wait to first appointment fell from 13.6 to 12.3 days, following the introduction of the government target. The proportion of cases waiting 5 weeks or less between first hospital appointment and treatment fell from 83.8 to 80.3%, and median waits for treatment increased from 21.4 to 24.1 days. We also examined the effects on waiting times of various sociodemographic and care related factors. A total of 85.7% of screening cases vs 67.9% of symptomatic cases were seen within 2 weeks, and 95.0% of cases treated with tamoxifen received treatment within 5 weeks, as opposed to 77.6% of cases treated with surgery, 81.2% of chemotherapy cases and 52.8% of radiotherapy cases. While waiting times from GP referral to first hospital appointment have improved since the introduction of the government target, times from first appointment to treatment have increased, and consequently total waiting times have changed little.

show abstract

One stop breast clinics—victims of their own success?A prospective audit of referrals to a specialist breast clinic

Cited by 34 publications

References 2 publications

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

Identifying suspected breast cancer: development and validation of a clinical prediction rule

Effect of the UK government's 2-week target on waiting times in women with breast cancer in southeast England

Contact Info

Product

Resources

About