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

Background From April 1, 1999, family physicians are required to refer all patients who have suspected breast cancer in the UK urgently to hospital, t o be seen within 14 days of referral. We investigated whether delays by pro viders in routine practice for diagnosis influence survival. Methods We did a retrospective analysis of 36 222 patients with breast canc er listed in the Yorkshire Cancer Registry. Data on delay after family-phys ician referral. hospital visit, and start of treatment were available, as w eil as on tumour grade and stage of presentation. Results There was no evidence that provider delays of longer than 90 days a dversely influenced survival. The time from family-physician referral to fi rst hospital visit changed little (median 10 vs 13 days) from 1976 to 1995, whereas time from first visit to first treatment doubted (7 vs 13 days). M ore 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 thos e 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 sign ificantly worse outcomes (p<0.001). Interpretation Delays by providers in months or more do not seem to be asso ciated with decreased survival in patients presenting with breast cancer. T he drive for all women with possible breast cancer to be seen within 14 day s will divert resources from other services and is not supported by this st udy.