Two week rule for breast
Two week rule for breastTracey IrvineConsultant Oncoplastic
SurgeonClinical Director Breast UnitOverviewCurrent pathwaysThe
realityThe futureRoom for improvementOther referralsCurrent
pathways1995 Guidelines for urgent breast referral introduced2000
DOH rolled out to other tumour sites2005 Taken under auspices of
NICE2007 Concerns majority diagnosed outside TWR2010 Breast becomes
two weeks for all (excludes cosmetic and family history)TWR
guidelines
RSCH breast referral formPatient Name: DOB: Address:Mobile/Home
preferred number for appointment: NHS No: GP Name: Surgery
Address:Telephone: WE AIM TO SEE ALL SYMPTOMATIC PATIENTS WITHIN 2
WEEKFamily History assessments and Cosmetic referrals will be seen
routinely.RSCH breast referral formRLThickening Lump Skin change
Nipple change Discharge Blood stained Pain Other
information..Previous Mammogram Yes No Where?.................
When? Signature of referring doctor://...Date:RSCH referral formFax
to: 01483 406632
Email to: [email protected]
Post to: Breast Unit, OPD 13, RSCH, Egerton Road, Guildford
GU27XX
The reality all referrals2010201120122013
2014Referrals90882079618772539Referrals per
week17.515.815.336.148.8Cancers859971139160Conversion
rate9.412.18.97.46.3TWR vs. Symptomatic2010201120122013
2014Referrals382/526369/451353/443709/11681010/1527Referrals per
week7.3/10.17.1/8.76.8/8.513.6/22.519.4/29.4Cancers69/1668/3148/2384/5594/66Conversion
rate %18.1/318.4/6.913.6/5.211.8/4.79.3/4.3RememberThe bean
counters are only asked to count cancers
Any discrete lump at any age should have a diagnosis even if
benign
There are many breast problems that benefit from a breast
specialist opinion
We are here to help!What is my reality?
The future - NICE guidanceBring down threshold to 3%Looked at
evidence PPV of various symptomsGuidelines same for women and
menSame for patients with a previous history of breast cancerThey
think this will reduce referrals
NICE guidanceRefer people using a suspected cancer pathway
referral (for an appointment within 2 weeks) for breast cancer if
they are aged 30 and over and have an unexplained breast lump with
or without pain. [new 2015]
PPV approx 10% (approaching 50 % in over 70s)NICE guidanceRefer
people using a suspected cancer pathway referral (for an
appointment within 2 weeks) for breast cancer if they are aged 50
and over with any of the following symptoms in 1 nipple only:
discharge or retraction or other changes of concern. [new 2015]
PPV 2-5%, over 10% in over 70s
NICE guidanceConsider a suspected cancer pathway referral (for
an appointment within 2 weeks) for breast cancer in people aged 30
and over with an unexplained lump in the axilla. [new 2015]
PPV felt to be over 3% by the panelNo breast pain?A lump in the
breast is painless
We will still find cancer in these patients opportunistic
screening PPV
