Influx of very low risk referrals sparks review of cancer services

NHS England is in talks about changing a pathway for women with breast problems after performance against the two-week target for them to be seen plummeted. 

HSJ understands discussions are ongoing between NHS England and the Association of Breast Surgery about changing the symptomatic breast pathway for some patients. This has been prompted by concerns that one stop breast clinics – which take those referred both via the symptomatic route and the standard two-week pathway for suspected cancer – are being flooded with very low risk patients, potentially meaning those at higher risk of cancer wait longer for tests and diagnosis.

The symptomatic pathway, which is for patients where cancer is not initially suspected by their GP, was introduced in 2010 because only about half of diagnosed breast cancers were being referred on the normal two-week pathway. The national target is for 93% of patients to be seen within two weeks. 

However, since 2018-19, national performance against this has reduced from 85.8% to 64.1% last year. 

There are concerns the pathway has led to too many patients being referred for diagnostic procedures which are inappropriate for their symptoms, preventing those who are more in need of such tests from accessing them in a timely manner.  

Association of Breast Surgery president Chris Holcombe said: “GPs tend to be quite cautious and send most people along even if the risk is quite small. We will get patients who are 25 and, to be honest, before they come to clinic, I could tell you with 99 per cent certainty they won’t have cancer. But they are worried as anything.”

Alternatives to the symptomatic breast pathway which could reduce pressure on one stop clinics and also offer patients a better service are now being evaluated, he said. “There are appropriate ways to see these patients other than in a very high resource clinic,” he added. “But they still need to be seen and seen quickly otherwise they will just bounce back into the one stop clinic.”

Read full story (paywalled)

Source: HSJ, 10 October 2022