Cancer Research study finds delays in referrals for breast cancer symptoms

A retrospective study, funded by Cancer Research UK and published in the BMJ Quality and Safety Journal, found that only 40% of patients with red flag signs and symptoms of cancer received an urgent referral within 14 days.

The study, which was carried out by the University of Exeter and the University College London, was based on cancer registration data between 2014 and 2015.  It looked at referrals across all primary care services, not just GPs, and found substantial variation between both clinicians and GP practices.

6 out of 10 high-risk cancer patients were not referred

The study looked at the records of almost 49,000 patients with red flag signs and symptoms of cancer and discovered that only six out of 10 patients presenting to primary care with a high-risk feature of potential cancer were not referred for further investigation in line with national guidelines.

The study further reported that six out of 10 of those patients went on to develop cancer within a year.

Breast cancer referral rates

Concerning breast cancer, the study showed that the highest referral rate was for a breast lump at 68% and that 3.5% of women presenting with a breast lump who did not receive a referral, were later diagnosed with breast cancer.

Red flag features for breast cancer for which urgent referrals are recommended were defined by the National Institute for Clinical Excellence (NICE) updated in 2015, and specify that medical professionals should refer people using a suspected cancer pathway referral for an appointment within two weeks for breast cancer if they:

• Are aged 30 and over and have an unexplained breast lump with or without pain;
• Are aged 50 and over with any of the following symptoms in one nipple only:
  • Discharge
  • Retraction
  • Other changes of concern

The guidelines also recommend that primary care services should consider a suspected cancer pathway referral for an appointment within two weeks for breast cancer in people:

• With skin changes that suggest breast cancer
• Aged 30 and over with an unexplained lump in the axilla

 It also says to consider non-urgent referrals for people aged under 30 with an unexplained breast lump with or without pain.

While it is somewhat reassuring to see that the highest referral rate was for a breast lump, it is clear from the guidelines that breast cancer can first present without any sign of a lump at all, and that these other presentations must all be taken equally as seriously.

Breast cancer diagnosis and the Covid-19 pandemic

To compound the findings reported in the BMJ study, Cancer Research UK analysed the recent data and confirmed that 10,600 fewer patients with breast cancer began treatment between April 2020 and March 2021.

2018 figures show that 15% of newly diagnosed cancers are breast cancer, therefore, it is obvious that the Covid-19 pandemic has had a disproportionate effect on the diagnosis of breast cancer. It seems that, very sadly, most of the women who remain undiagnosed will be in the early stage of their disease which is eminently treatable and often curable.

Baroness Delyth Morgan, Chief Executive at the charity, Breast Cancer Now, recently responded to these concerns saying:

“Urgent investment in the chronically understaffed imaging and diagnostic workforce will enable significant headway in tackling the breast screening backlog and help ensure women with possible symptoms see a specialist quickly so that if they have breast cancer it’s diagnosed as soon as possible – only then will women receive the best care and have the best chances of survival.”

Inequality of diagnosis amongst socio-economic groups

A particularly worrying feature highlighted by the BMJ study concerns the inequality of diagnosis amongst socio-economic groups. It seems that women from more deprived socio-economic groups presenting with a breast lump were less likely to receive a referral.

The study reports that, because few women with breast cancer delay presentation, the association between deprivation and referral is likely to reflect differences after women have presented to their GP. The study references various research papers on this subject and concludes that this disparity occurs because patients with a higher socio-economic status tend to be more effectively able to communicate their symptoms and concerns. This, in turn, means that GPs’ communications with them tend to be more patient-centred than their communications with patients from deprived groups. Ultimately, this may result in a closer alignment in the perception of a symptom’s significance between GPs and more affluent groups, which will influence the GP’s decision to refer.

This finding paints an extremely troubling picture for everyone and is especially worrying for those in lower socio-economic groups and for people seeking medical help where English is not their first language. This finding also resonates with our previous blog concerning pregnancy outcomes amongst black and ethnic minority communities.

Blog | Why are BAME women more likely to die or suffer injury in childbirth?  

The delays caused by the pandemic were in many ways unavoidable, however, better adherence to the NICE guidelines as a result of this study will hopefully encourage greater equality in healthcare between socio-economic groups.

The importance of early diagnosis

This study sheds a negative light on cancer diagnosis in the UK, however, it’s important to remember that if breast cancer is diagnosed early, the outlook for women is good.

Cancer Research UK has confirmed that there have been great strides in recent years, with mortality rates from breast cancer falling almost 40% since the 1970s. This is extremely reassuring to women and we hope that as various causes of the delayed diagnosis of breast cancer have now been identified, steps will be taken to try and address some of these issues.

Get in touch with our delayed and misdiagnosis solicitors

Although GPs and clinical specialists should recognise the signs of cancer, sometimes mistakes happen and ‘red flags’ for cancer are missed. If you suspect that you or a loved one has experienced delayed or misdiagnosis of cancer, you may have grounds to claim compensation.

For an initial chat with a member of our medical negligence team, call us on 0117 325 2929 or fill out our online enquiry form.