Two-week rule: Has prioritisation of breast referrals by general practitioners improved?

Imkampe, Anne Kathrin; Bendall, Stephen; Chianakwalam, C.

doi:10.1016/j.breast.2006.02.002

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…showed that 32% of nonurgent referrals to breast clinics went on to be diagnosed with breast cancer . These types of figures prompted the “2‐week for all” referral system . Our study showed that the cancer diagnoses were all from the area of concern according to the initial referral, thus warranting targeted imaging.…”

Section: Discussionmentioning

confidence: 67%

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Will Adherence to New Guidance Lead to Missed Cancer Diagnoses? Evaluation of Limiting Symptomatic Mammograms to Over Forties

2013

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Within the United Kingdom, a recent change in "Best Practice Guidance" has suggested that mammograms for symptomatic breast patients, with a clinically benign examination, should be limited to those over 40 years . This has led to anxiety over missing cancer diagnoses in the 35-39 year-old age group. This study aimed to assess the impact of the new guidance upon a NHS Breast unit with a particular focus on safety. Two cancer data bases (BASO and SOMERSET) were used to identify thirty-three patients aged 35-39 years diagnosed with breast cancer between January 2007 and June 2011. Case notes were retrieved and retrospectively analyzed for trends during clinical (P1-P5) and radiological assessment (using Royal College Radiologists Breast Group classification-M1-5, U1-5). Sensitivity and false-negative rates for each modality were calculated. Sensitivities of clinical examination, mammography, and ultrasound for detecting malignancy were 72.7%, 78.8%, and 93.9%, respectively. Within the clinically benign group (P1 and P2), mammography and ultrasound showed sensitivities of detecting malignancy of 55.5% and 88.9%, respectively, with three extra cancers being identified by ultrasound when mammography was graded less than M3 (indeterminate lesion-requiring biopsy). Importantly, no cancers would have been missed if the new guidance had been adhered to. This study has shown that mammography has no additional diagnostic benefit as first-line imaging in symptomatic breast patients aged 35-39 years. It has confirmed that implementation of the new Best Practice Guidance is safe, when used in the setting of triple assessment, to ensure cancer diagnoses are not missed.

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Section: Discussionmentioning

confidence: 67%

“…Imkampe et al. showed that 32% of nonurgent referrals to breast clinics went on to be diagnosed with breast cancer . These types of figures prompted the “2‐week for all” referral system .…”

Section: Discussionmentioning

confidence: 99%

Will Adherence to New Guidance Lead to Missed Cancer Diagnoses? Evaluation of Limiting Symptomatic Mammograms to Over Forties

2013

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“…These include raising awareness of red-flag signs and improved training for GP registrars in the assessment of squint; however, we suggest that the most useful way of improving referrals would be the implementation of a proforma with tick-boxes for positive and negative features. Proformas have been shown to improve the quality of referrals in other specialities (Djemal, Chia, & Ubaya-Narayange, 2004; Imkampe, Bendall, & Chianakwalam, 2006). We include our suggested form in Fig.…”

Section: Recommendationsmentioning

confidence: 99%