Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines

Cochrane, R.; Singhal, Hemant; Monypenny, I.; Webster, David; Lyons, K.; Mansel, RE

doi:10.1016/s0748-7983(97)92220-4

Cited by 34 publications

(17 citation statements)

References 2 publications

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“…Cytology can explore breast lesions in three distinct ways, Fine Needle aspiration cytology (FNAC), scraping of skin (SS), and smearing of nipple discharge (ND) (Cochrane et al,1997). FNAC of breast lumps is an important part of triple assessment (the other two are clinical examination and mammography) of palpable breast lumps (Willems et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Cytomorphologic Patterns of Breast Lesions in Sudanese Patients: Lessons Learned from Fine Needle Aspiration Cytology

Almobarak

Elhassan²,

Elhoweris³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Introductionmentioning

confidence: 99%

Cytomorphologic Patterns of Breast Lesions in Sudanese Patients: Lessons Learned from Fine Needle Aspiration Cytology

Almobarak

Elhassan²,

Elhoweris³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Initial research reported that these guidelines did improve the referral process, increasing appropriate referrals in those subsequently diagnosed with breast cancer and reducing potentially inappropriate referrals of those women at low risk of breast cancer. [8][9][10] A further change in the procedure for diagnosing breast cancer was the introduction of the '2-week rule' by the UK Department of Health, which set targets for clinics to see patients with suspected breast cancer within a 2-week period, prioritising patients as being 'urgent' and other referrals as 'routine'. 11 An improvement in the diagnostic process from this initiative has not been realised; observational research shows that the number of cases of breast cancers in the 2-week rule population has fallen, while the number of those in the routinely referred group has increased.…”

Section: Introductionmentioning

confidence: 99%

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

McCowan¹,

Donnan²,

Dewar³

et al. 2011

Br J Gen Pract

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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...

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“…Other studies [10,11] have applied 1995 [12] breast referral guidelines to referral letters of patients and similarly found high levels of 'inappropriate' referrals. These studies also reveal assumptions about mounting public awareness of breast cancer.…”

Section: The Need To Prevent Overload Of Secondary Carementioning

confidence: 99%

“…These studies also reveal assumptions about mounting public awareness of breast cancer. For instance, the UK National Breast Screening Programme is reported as leading to an increase in awareness of breast disease and increased number of women presenting with breast problems to GPs [10], misquoting as evidence a study which had investigated the effect of a health education campaign and found no difference in consultation rates to GPs [13]. Similarly increased demand for specialist breast cancer services is blamed on increased public awareness of, and media attention to, breast cancer [11] also misquoting the same study [13].…”

Section: The Need To Prevent Overload Of Secondary Carementioning

confidence: 99%

The 2-week rule for patients with suspected breast cancer: what can be learnt by analysing policy documents?

Cornford

Oswald

2004

Health Policy

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Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines

Cited by 34 publications

References 2 publications

Cytomorphologic Patterns of Breast Lesions in Sudanese Patients: Lessons Learned from Fine Needle Aspiration Cytology

Cytomorphologic Patterns of Breast Lesions in Sudanese Patients: Lessons Learned from Fine Needle Aspiration Cytology

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

The 2-week rule for patients with suspected breast cancer: what can be learnt by analysing policy documents?

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