Page last updated at 07:41 GMT, Monday, 31 December 2007

Cancer referral 'confusing' GPs

Breast examination
Breast awareness and screening help early diagnosis

Many GPs do not know how to deal with women who are worried they may have breast cancer, a survey has suggested.

Breakthrough Breast Cancer found confusion about when to refer people as urgent cases rather than routine ones.

Its survey of 200 GPs for BBC Radio 4's Today also suggested few GPs initiated conversations about breast cancer or offered screening to at-risk groups.

The British Medical Association said unnecessarily treating cases as urgent would put hospitals under pressure.


The survey showed that while most GPs followed guidelines set out by the National Institute for Health and Clinical Excellence (NICE) on breast cancer referrals, some were confused about when to treat them as routine or urgent.

It found 10% of GPs would refer a woman who had previously had confirmed breast cancer routinely, when NICE guidelines state she should be seen urgently.

Breast cancer scan
Experts want GPs to increase awareness of breast cancer

In addition, the study said 34% of family doctors would refer routinely a female patient aged under 30 who had reported a lump and had reasons for concern, such as a family history of the disease, when NICE advises such a case should be treated as urgent.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, said it was "surprising" that all GPs were not sufficiently aware of the risks of breast cancer and how urgently cases should be dealt with.

"If you go to your GP and the GP says 'well there may be something of concern here [but] it may not be very important' you don't go away and forget about it, you go away and worry."

GPs and Primary Care Trusts have a key role in helping women understand the benefits of breast awareness and breast screening
Jeremy Hughes
Breakthrough Breast Cancer

The Department of Health said: "Over 99% of patients with suspected cancer are now seen by a specialist within two weeks of being referred by their GP."

By December 2009, all women referred to a specialist with breast symptoms - even if cancer is not suspected - would be seen within a fortnight, a spokesman said.

The British Medical Association said GPs were not confused about how to handle breast cancer.

"Of course, it's better to refer urgently if you suspect or even wonder if a patient has breast cancer," said Dr Laurence Buckman. "But very often women with breast disease do not have cancer, and clearly not.

"They should not be lumped together with urgent cases because what will happen is if everyone is made an urgent case there will not be enough time in outpatients."

Graph showing incidence and mortality rates of breast cancer

The survey also found that most of the GPs questioned were not proactively promoting breast cancer awareness and screening to their patients aged over 50 - one of the most at-risk groups.

Only 16% of family doctors said they spoke to older women about the disease and its symptoms whenever they had an appointment, while 80% said they did so only when asked by a patient.

According to Breakthrough Breast Cancer, although UK survival rates have improved in recent years, they are still lower than in the US and many other European countries.

The risk of death in the first six months after diagnosis remains higher in the UK than in the rest of Europe. The UK's mortality rate from breast cancer is the fourth highest in Europe.


Mr Hughes said this showed "a real need for education about the signs and symptoms of the disease and breast screening".

"GPs and Primary Care Trusts have a key role in helping women understand the benefits of breast awareness and breast screening," he added.

Earlier this year, the charity also found widespread confusion among women about the signs of breast cancer.

Its survey of 1,190 women over 50 found a quarter wrongly thought a persistent cough was a sign of breast cancer.

Some 81% wrongly believed a mole on the breast could be a symptom, while a third incorrectly linked an extra nipple to the disease.

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