Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis

Lancet. 1999 Apr 3;353(9159):1132-5. doi: 10.1016/s0140-6736(99)02374-0.


Background: From April 1, 1999, family physicians are required to refer all patients who have suspected breast cancer in the UK urgently to hospital, to be seen within 14 days of referral. We investigated whether delays by providers in routine practice for diagnosis influence survival.

Methods: We did a retrospective analysis of 36,222 patients with breast cancer listed in the Yorkshire Cancer Registry. Data on delay after family-physician referral, hospital visit, and start of treatment were available, as well as on tumour grade and stage of presentation.

Results: There was no evidence that provider delays of longer than 90 days adversely influenced survival. The time from family-physician referral to first hospital visit changed little (median 10 vs 13 days) from 1976 to 1995, whereas time from first visit to first treatment doubled (7 vs 13 days). More than 8% of patients younger than 50 years delayed longer than 90 days, compared with 3% of patients older than 50 years (p<0.001). 48% of younger patients had their first treatment within 30 days compared with 64% of those older than 50 (p<0.001). The survival for 5708 patients diagnosed in 1986-90 selected for survival analysis was 63% at 5 years, and 51% at 8 years. Patients who presented early and were treated in less than 30 days had significantly worse outcomes (p<0.001).

Interpretation: Delays by providers in diagnosis of 3 months or more do not seem to be associated with decreased survival in patients presenting with breast cancer. The drive for all women with possible breast cancer to be seen within 14 days will divert resources from other services and is not supported by this study.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / therapy
  • Cause of Death
  • England / epidemiology
  • Family Practice / statistics & numerical data*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • Referral and Consultation / statistics & numerical data*
  • Registries
  • Retrospective Studies
  • Survival Analysis
  • Time Factors