Cochrane R A, Davies E L, Singhal H, Sweetland H M, Webster D J, Monypenny I J, Lyons K, Mansel R E
University Department of Surgery, University Hospital of Wales, UK. The Cardiff Breast Group.
Eur J Surg Oncol. 1999 Jun;25(3):251-4. doi: 10.1053/ejso.1998.0636.
When the National Breast Referral Guidelines were applied to our local GPs letters immediately prior to their release in January 1996, it was shown that on the basis of the GPs own conclusions that 29% of symptomatic women could have been managed initially by their own GP without missing any carcinomas. We conducted this study at the Rapid Access Breast Clinic at the University Hospital of Wales to determine if the breast referral practices of local GPs have altered due to the breast referral guidelines.
We studied 2332 referrals from the inception of the Rapid Access Clinic in May 1995 to the issue of the guidelines, and 2421 referrals from May 1996 to the end of the year. Random samples of 600 patients were drawn from each year and the referral letters were scored as within or outside the guidelines. Family history patients were excluded.
There was an 11% fall in referrals outside the guidelines in the under 50s (chi-squared=<0.001) but the 7% fall in the over 50s was not significant.
The Breast Referral Guidelines seem to have been effective in reducing the higher level of inappropriate referrals in younger patients at less risk of carcinoma.
在1996年1月国家乳腺转诊指南发布前夕，将其应用于我们当地全科医生（GP）的信件时发现，根据全科医生自己的结论，29%有症状的女性最初可由其自己的全科医生进行处理，而不会漏诊任何癌症。我们在威尔士大学医院的快速通道乳腺诊所开展了这项研究，以确定当地全科医生的乳腺转诊做法是否因乳腺转诊指南而发生了改变。
我们研究了从1995年5月快速通道诊所成立到指南发布期间的2332例转诊病例，以及1996年5月至当年年底的2421例转诊病例。每年从这些病例中随机抽取600例患者样本，并根据是否符合指南对转诊信件进行评分。有家族病史的患者被排除在外。
50岁以下不符合指南的转诊病例减少了11%（卡方检验，P<0.001），但50岁以上病例减少7%并不显著。
乳腺转诊指南似乎有效地减少了年轻患者中较高水平的不适当转诊，这些年轻患者患癌风险较低。
