Abstract
Background
Referrals to symptomatic breast clinics have increased significantly in recent years with unchanged numbers of detected cancers. The general practitioner (GP) referral information relating to this increased patient volume causes anxiety and potentially creates confusion and future medicolegal issues if inaccurate.
Aims
To compare GP triage category requests and clinical findings with those determined by the breast centre.
Methods
1,014 consecutive referrals to a symptomatic breast service were included. GP triage request category and clinical findings were prospectively recorded and compared to cancer centre surgeon triage category, clinical findings and cancer detection rates.
Results
GPs requested urgent appointments for 49 % of referrals, only 22 % were considered urgent on triage at the cancer centre. The triage category request was downgraded in 56 % of referrals from urgent to routine. Thirty-three cancers were detected, representing 3 % of referrals. Eighty-eight percent of cancers were identified in the group with positive clinical findings at the breast clinic. 24 % of the new referrals were for mastalgia alone. In the 55 % of referred cases where GPs reported a clinical abnormality, only 39 % of these had a clinical finding confirmed by the breast surgeon.
Conclusions
There is poor correlation between GP triage category request and those assigned by the breast unit. GP referrals indicating patients with a clinical abnormality was discordant with specialist findings in 61% of cases. The frequency of overstating of clinical findings by GPs is such that subsequent cancer diagnosis does not imply failure of a preceding triple assessment process.
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References
O’Keefe B (2000) Development of services for symptomatic breast disease: report of the sub-group to The National Cancer Forum. Department of Health, Hawkins House, Dublin, Ireland
Health Information and Quality Authority (HIQA) (2008) Investigation report into the pathology service and the symptomatic breast disease service at University Hospital Galway. Georges Lane, Dublin 7, Ireland
National Cancer Registry (2011) Cancer in Ireland 2011: annual report of the National Cancer Registry. NCR, Cork
Barber M, Jack W, Dixon J (2004) Diagnostic delay in breast cancer. Br J Surg 91:49–53
Jenner D, Middleton A, Webb W, Oommen R, Bates T (2000) In hospital delay in the diagnosis of breast cancer. Br J Surg 87:914–919
Goodson WH III, Moore DH II (2002) Causes of physician delay in the diagnosis of breast cancer. Arch Intern Med 162:1343
Arndt V, Stürmer T, Stegmaier C, Ziegler H, Becker A, Brenner H (2003) Provider delay among patients with breast cancer in Germany: a population-based study. J Clin Oncol 21:1440–1446
Willett AM, Michell MJ, Lee MJR (eds) (2010) Best practice diagnostic guidelines for patients presenting with breast symptoms Association of Breast Surgeons
National Cancer Control Program (2010) Key performance indicators report for symptomatic breast disease services
National Breast Cancer GP Referral Guidelines (2009) National Cancer Control Programme, Parnell St., Dublin, Ireland
Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS (2013) Epidemiology and prognosis of breast cancer in young women. J Thorac Dis 5:S2
Kopans DB, Kopans D (2007) Breast imaging. Lippincott Williams & Wilkins Philadelphia, PA
Kern KA (2001) The delayed diagnosis of breast cancer: medicolegal implications and risk prevention for surgeons. Breast disease 12:145–158
Singh H, Sethi S, Raber M, Petersen LA (2007) Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol 25:5009–5018
Barlow WE, White E, Ballard-Barbash R et al (2006) Prospective breast cancer risk prediction model for women undergoing screening mammography. J Natl Cancer Inst 98:1204–1214
Joensuu H, Asola R, Holli K, Kumpulainen E, Nikkanen V, Parvinen L-M (1994) Delayed diagnosis and large size of breast cancer after a false negative mammogram. Eur J Cancer 30:1299–1302
Poplack SP, Tosteson TD, Kogel CA, Nagy HM (2007) Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. Am J Roentgenol 189:616–623
Panel NIoHCD (1997) National Institutes of Health consensus Development conference statement: breast cancer screening for women ages 40–49, January 21–23, 1997. JNCI Monogr: vii–xviii
Taplin SH, Rutter CM, Finder C, Mandelson MT, Houn F, White E (2002) Screening mammography: clinical image quality and the risk of interval breast cancer. Am J Roentgenol 178:797–803
Joyce D, Alamiri J, Lowery A et al (2014) Breast clinic referrals: can mastalgia be managed in primary care? Irish J Med Sci: 1–4
Khan SA, Apkarian AV (2002) Mastalgia and breast cancer: a protective association? Cancer Detect Prev 26(3):192–196
Alamiri J, Lowery A, Rajendran S, Hill A (2013) Breast clinic referrals—should mastalgia be managed in primary care? BMC Proc Bio Med Central 7:O7
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The authors declare no competing interests as defined by the journal or other interests that might be perceived to influence the results and discussion reported in this paper.
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Ahmed, A., Marginan, A., Sweeney, K. et al. Medicolegal implications of accuracy of GP referral letters to specialist breast clinic. Ir J Med Sci 185, 69–73 (2016). https://doi.org/10.1007/s11845-014-1223-z
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DOI: https://doi.org/10.1007/s11845-014-1223-z