Sainsbury R, Johnston C, Haward B
Department of Surgery, Huddersfield Royal Infirmary, UK.
Lancet. 1999 Apr 3;353(9159):1132-5. doi: 10.1016/s0140-6736(99)02374-0.
From April 1, 1999, family physicians are required to refer all patients who have suspected breast cancer in the UK urgently to hospital, to be seen within 14 days of referral. We investigated whether delays by providers in routine practice for diagnosis influence survival.
We did a retrospective analysis of 36,222 patients with breast cancer listed in the Yorkshire Cancer Registry. Data on delay after family-physician referral, hospital visit, and start of treatment were available, as well as on tumour grade and stage of presentation.
There was no evidence that provider delays of longer than 90 days adversely influenced survival. The time from family-physician referral to first hospital visit changed little (median 10 vs 13 days) from 1976 to 1995, whereas time from first visit to first treatment doubled (7 vs 13 days). More than 8% of patients younger than 50 years delayed longer than 90 days, compared with 3% of patients older than 50 years (p<0.001). 48% of younger patients had their first treatment within 30 days compared with 64% of those older than 50 (p<0.001). The survival for 5708 patients diagnosed in 1986-90 selected for survival analysis was 63% at 5 years, and 51% at 8 years. Patients who presented early and were treated in less than 30 days had significantly worse outcomes (p<0.001).
Delays by providers in diagnosis of 3 months or more do not seem to be associated with decreased survival in patients presenting with breast cancer. The drive for all women with possible breast cancer to be seen within 14 days will divert resources from other services and is not supported by this study.
从1999年4月1日起，英国要求家庭医生将所有疑似乳腺癌患者紧急转诊至医院，并在转诊后14天内安排就诊。我们调查了常规诊疗过程中医疗机构的诊断延迟是否会影响生存率。
我们对约克郡癌症登记处登记的36222例乳腺癌患者进行了回顾性分析。可获取家庭医生转诊后、医院就诊及开始治疗后的延迟数据，以及肿瘤分级和就诊时的分期数据。
没有证据表明医疗机构超过90天的延迟会对生存率产生不利影响。从1976年到1995年，从家庭医生转诊到首次医院就诊的时间变化不大（中位数分别为10天和13天），而从首次就诊到首次治疗的时间增加了一倍（从7天增至13天）。50岁以下的患者中，超过8%的人延迟超过90天，而50岁以上的患者中这一比例为3%（p<0.001）。48%的年轻患者在30天内接受了首次治疗，而50岁以上患者的这一比例为64%（p<0.001）。对1986 - 1990年确诊的5708例患者进行生存分析，5年生存率为63%，8年生存率为51%。早期就诊且在30天内接受治疗的患者预后明显更差（p<0.001）。
医疗机构3个月或更长时间的诊断延迟似乎与乳腺癌患者生存率降低无关。要求所有可能患有乳腺癌的女性在14天内就诊会将资源从其他服务中转移出来，本研究不支持这一做法。
