Breast cancer fast-track programme - Evolution and guidelines to prioritize patient referral

Background

In our country there are a breast cancer (BC) Screening (45-70) but actually some patients are diagnosted out of it so Breast cancer fast-track program (BCFP) has proved to be an effective system to efficiently assess symptomatic women to prompt diagnose. The aim of this study is to develop a clinical prediction rule in order to better identify BC to reduce time interval between patient referral by the primary care (PC) physician to the specialist, diagnosis of BC, and start treatment.

Methods

From 2009 to 2015 we analyzed retrospectively all proposals sent from PC with suspected BC to the oncology coordinator at the Clinico-Malvarrosa Health Department in Valencia. We studied the different variables for which patients were referred to BCFP and analyzed if any of them could be related to increased chance of developing BC. Variables recorded include the presence/absence of lump, inflammation, pain, ulceration, skin change, nipple changes and secretion of the nipple, nodularity and family history. To investigate a grade of association we performed a Pearson Chi Square test using STATA program.

Results

810 patients were considered for the study. 156 were diagnosed with BC (19, 3%). The mean of age was 65, 6 years ( 27- 94). 55 patients were between 45 and 70 years and 34 out of them were going regularly screening. 78, 2%, were diagnosed with localized stage. Above the patients diagnosed with BC, mean of time till specialist assessment was 16,8 days (Standard Deviation, SD 10,9); 11,5 days (SD 13,7) were needed for histopathological diagnosis, and first treatment was administered after 26,5 days (SD 18,2). Among the evaluated variables four were identified to be highly associated with BC: fixed chest lesion [Odds ratio, OR 12,7: IC 95% 7,8-20,7], lump lesion in women older than 50 years [OR 8.9: IC 95% 6,1-13,2], > 3 cm breast nodule [OR 8,2: IC 95% 5,3-12,8] and nipple secretion and retraction [OR 2,1: IC 95% 1,3-3,1].

Conclusions

The results show that the implementation of BCFP has managed to increase cooperation between the different healthcare professionals involved in BC leading to a faster diagnosis of BC. We have identified four variables that are significantly associated with BC, aiming to decrease the evaluation time by the specialist and start earlier the treatment.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

INCLIVA

Disclosure

All authors have declared no conflicts of interest.