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Clearing the path to secondary breast cancer diagnosis in England

People with secondary breast cancer often tell us about difficulties getting diagnosed quickly. We hear of people having to visit their GP several times before having symptoms diagnosed, feeling like symptoms are not taken seriously enough and, for some – having to attend A&E. Having to navigate this can be very difficult, at an already challenging time.

A couple speaking to a breast cancer nurse

Recognising symptoms

Difficulties recognising symptoms among healthcare professionals is a key barrier to faster secondary breast cancer diagnosis. Symptoms can be vague and mistaken for other conditions.

A 2019 survey we commissioned found the following challenges:

  • Almost a quarter (24%) of GPs and over one-third (37%) of practice nurses mentioned  the late identification of symptoms among healthcare professionals
  • 37% of practice nurses reported a lack of training given to primary care professionals on the signs of secondary breast cancer

Patients may also find it difficult to spot the signs of secondary breast cancer. As demand for NHS health services continues to grow, it's important that people feel empowered to report concerns to a healthcare professional if they're worried their cancer has come back. Our briefing highlights the importance of ensuring the below:

  • Patients who are finishing primary breast cancer treatment know about the possibility their cancer could return
  • Patients are aware of the signs of secondary breast cancer and who they can report concerns to

It also signposts to resources like our After breast cancer – what now booklet, which explains the steps people can take if their worried about symptoms.    

Referral pathways

Referral routes can also be tricky to navigate. Some healthcare professionals highlight a lack of urgent referral pathways for vague symptoms as a challenge to quick diagnosis.

Our policy briefing examines a new pathway for non-specific symptoms (NSS pathway), which will be expanded across England by March 2024. It allows clinicians to quickly refer on patients with vague symptoms for further tests, the purpose being to confirm or exclude a cancer diagnosis within a 28-day timeframe. 

There are other referral pathways that may be more effective for people with secondary breast cancer symptoms, such as direct referral into a multidisciplinary team. But we welcome the potential of the NSS pathway for people unable to be referred via these alternative routes, whether it's because it's not possible in practice or because they haven’t had primary breast cancer.

Our briefing

  • Provides an overview of the NSS pathway and its potential to fast-track certain people with secondary breast cancer symptoms for further tests in England
  • Makes recommendations on how it can be improved
  • Highlights how rapid diagnosis can be improved more generally, for people with symptoms of secondary breast cancer, regardless of what referral route is used

We’re calling for:

  • Clearer guidance for healthcare professionals so that patients completing primary breast cancer treatment know secondary breast cancer symptoms and who to report concerns to
  • A dedicated cancer workforce plan, with numbers of staff needed to diagnose and treat cancer now and in the future

Clearing the path to diagnosis

NSS Pathway Report

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