Age and sex can predict cancer risk in people referred with breast symptoms - The BMJ

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1. Toral Gathani, senior clinical research fellow1 2,
2. Ramsey Cutress, professor of breast surgery David Dodwell, senior clinical research fellow32 4,
3. Kieran Horgan, consultant breast surgeon5,
4. Cliona Kirwan, professor of surgical trials6 7,
5. Hilary Stobart, independent patient advocate8,
6. Sau Wan Kan, data analyst1,
7. Gillian Reeves, professor of epidemiology1,
8. Sian Sweetland, senior statistician1

1. ¹Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
2. ²Oxford University Hospitals NHS Foundation Trust, Oxford, UK
3. ³Cancer Sciences, University of Southampton and University Hospitals Southampton, Southampton, UK
4. ⁴Nuffield Department of Population Health, University of Oxford, Oxford, UK
5. ⁵Department of Breast Surgery, St James’s Hospital, Leeds, UK
6. ⁶Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
7. ⁷Nightingale Breast Centre, Manchester University NHS Foundation Trust, Manchester, UK
8. ⁸Independent Cancer Patients’ Voice, London, UK

1. Correspondence to: T Gathani toral.gathani{at}ndph.ox.ac.uk

Toral Gathani and colleagues argue that risk stratification by age and sex should be used to help manage demand on breast clinics efficiently to minimise delays in diagnosis

Breast cancer is the most common malignancy in women globally.1 Improvements in breast cancer survival over several decades are partly attributed to population based breast screening programmes and rapid access to specialist diagnostic services for patients with breast symptoms. These facilitate diagnosis at early stages and prompt access to treatment. Even delays as short as a month in diagnosis and starting treatment can be associated with poorer outcomes.234

Population based breast screening programmes have been the subject of much international comparison, investigation, and debate. However, less is known about the performance of healthcare services that assess women and men referred from primary care with symptoms that may indicate breast cancer, even though these services identify a large proportion of people with breast cancer. In England, six out of 10 people with breast cancer are diagnosed after referral with symptoms.5

Services for breast symptoms are under increasing pressure. Over five million people with breast symptoms have been referred for urgent or routine assessment over the past decade in England, making it the highest volume cancer referral service in the NHS.6 With such high overall volumes, small mismatches between capacity and demand rapidly lead to large numbers of patients waiting for assessment and may delay the diagnosis of breast cancer in some patients. In 2021-22, four out of 10 patients referred urgently or routinely waited longer than the recommended 14 days for assessment, the lowest performance for timely assessment among all cancers.7

The challenge of managing the volume of referrals has led to calls for a review of breast services, including the development and evaluation of safe …

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Age and sex can predict cancer risk in people referred with breast symptoms - The BMJ
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