A Ahmed1, A Marginan2, K Sweeney2, C Malone2, R McLaughlin3,4, M Kerin2. 1. Department of Surgery, University College Hospital Galway (UCHG)/National University of Ireland (NUI), Galway, Ireland. dr.abubakr@gmail.com. 2. Department of Surgery, University College Hospital Galway (UCHG)/National University of Ireland (NUI), Galway, Ireland. 3. Department of Surgery, University College Hospital Galway (UCHG)/National University of Ireland (NUI), Galway, Ireland. ray.mclaughlin@hse.ie. 4. Department of Academic Surgery, University College Hospital Galway, Galway, Ireland. ray.mclaughlin@hse.ie.
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.
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.
Entities:
Keywords:
Breast cancer; GP; Interval cancer; Medicolegal; Symptoms
Authors: William E Barlow; Emily White; Rachel Ballard-Barbash; Pamela M Vacek; Linda Titus-Ernstoff; Patricia A Carney; Jeffrey A Tice; Diana S M Buist; Berta M Geller; Robert Rosenberg; Bonnie C Yankaskas; Karla Kerlikowske Journal: J Natl Cancer Inst Date: 2006-09-06 Impact factor: 13.506
Authors: Stephen H Taplin; Carolyn M Rutter; Charles Finder; Margaret T Mandelson; Florence Houn; Emily White Journal: AJR Am J Roentgenol Date: 2002-04 Impact factor: 3.959