The National Breast Referral Guidelines have cut down inappropriate referrals in the under 50s

Aims: When the National Breast Referral Guidelines were applied to our loca l GPs letters immediately prior to their release in January 1996, it was sh own that on the basis of the GPs own conclusions that 29% of symptomatic wo men could have been managed initially by their own GP without missing any c arcinomas. We conducted this study at the Rapid Access Breast Clinic at the University Hospital of Wales to determine if the breast referral practices of local GPs have altered due to the breast referral guidelines. Methods: We studied 2332 referrals from the inception of the Rapid Access C linic in May 1995 to the issue of the guidelines, and 2421 referrals from M ay 1996 to the end of the year. Random samples of 600 patients were drawn f rom each year and the referral letters were scored as within or outside the guidelines. Family history patients were excluded. Results: There was an 11% fall in referrals outside the guidelines in the u nder 50s (chi-squared = <0.001) but the 7% fall in the over 50s was not sig nificant. Conclusions: The Breast Referral Guidelines seem to have been effective in reducing the higher level of inappropriate referrals in younger patients at less risk of carcinoma.