October 2023 saw changes to the way cancer waiting times are measured in England. We look at how this has impacted people with possible signs of breast cancer.
The biggest change was the introduction of the ‘Faster Diagnosis Standard’, (FDS). It’s the target for people to get a diagnosis or have cancer ruled out within 28 days of their GP referral. This measure replaced the standard for suspected cancer referrals, of 93% of cases to be seen within 2 weeks.
NHS England (NHSE) is aiming for 75% of patients to meet the FDS standard by March 2024. We were initially concerned that the 75% target would be a step backwards for breast cancer, as most people who are seen by a specialist within 2 weeks will already get their test results well within 28 days.
But as a result of our tireless campaigning, NHSE recognised the need to be more ambitious and set an expectation that more than 90% of urgent breast cancer referrals should be diagnosed or ruled out within 28 days.
What’s the issue?
While we welcomed NHSE’s higher expectation for breast cancer diagnosis, we still have significant concerns about the current waiting times for people with possible breast cancer symptoms.
Looking at the monthly data published by NHSE, we have the following concerns:
1. Breast cancer isn’t meeting the 90% expectation for FDS performance
There are 3 urgent referral pathways to a breast cancer diagnosis:
- Suspected breast cancer
- Breast symptoms where cancer isn’t initially suspected
- Referrals from the screening programme Looking at 2023 FDS data at a national level, the 90% level isn’t always met
2. It’s taking much longer to confirm a breast cancer diagnosis than rule it out
The FDS covers everyone who is urgently referred, but it’s often a lot faster to rule out breast cancer than confirm it. This is clear when you take a closer look at the data. NHSE figures show that the percentage of people who are diagnosed with breast cancer within 28 days is regularly below the 75% target.
Only around 5% of people urgently referred with possible breast cancer symptoms go on to be diagnosed. This means overall FDS performance across all referrals can stay high, even when a much lower proportion of breast cancers are confirmed within 28 days.
While it’s important to give quick reassurance to people who don’t have breast cancer, a rapid diagnosis is vital to starting treatment promptly. The current FDS doesn’t reflect this priority.
3. Too many breast cancer patients aren’t starting their treatment on time
As well as introducing the FDS, NHSE combined a few different targets into one - for 85% of cancer patients to start treatment within 62 days of urgent referral.
This target was met for breast cancer pre-COVID-19, but since the pandemic, performance has dropped.
From the data, we know that most breast cancer patients do start their treatment ‘on time’ - within 31 days of agreeing a treatment plan. This means that the major delays are happening within the diagnostic pathway. This can be explained in part by the lower proportion of breast cancers being diagnosed within 28 days. But it’s also due to delays in getting a full diagnosis, beyond just confirming someone has breast cancer.
A full diagnosis includes information on the type of breast cancer a person has, whether the tumour has hormone receptors, HER2 receptors, or is triple negative. The type of tumour someone has affects what treatment they will receive, so waiting for this information can delay patients from starting treatment.
Long waiting times for test results, particularly for HER2 status, happen when services are struggling with high levels of demand. It’s important that there are enough staff and resources across the whole diagnostic pathway, including areas like pathology, so people can be given a full diagnosis and start treatment within 62 days.
4. People are still waiting longer to be seen
The percentage of urgent referrals that are seen within 2 weeks is still published even though the target was removed. The data shows the strain that services are under, with waiting times performance declining over recent years.
While we support the focus on providing a rapid diagnosis, we recognise the stress and anxiety that comes with waiting to be seen for an urgent referral. That’s why we’re keeping an eye on this data and will continue to talk about waiting times as an important issue for people affected by breast cancer.
What do we want to see next?
It’s clear that despite positive top-line FDS data, more must be done to deliver genuine improvements in diagnosis waiting times.
Investing in the staff who run diagnostic services is essential for achieving this. We welcomed NHSE’s long-term workforce plan earlier this year, but we urgently need to know how they’ll invest in the cancer workforce, so that waiting time standards can be met.
NHSE need to focus on increasing the proportion of people with breast cancer confirmed within 28 days, not just improving top-line FDS performance. They should publish data just on the percentage of people who have breast cancer diagnosed within 28 days, separate to cases where it is ruled out. This will make sure services are aware of the performance gap and can monitor it.
NHSE is also creating ‘best practice timed pathways’ to show how each type of cancer can be diagnosed within 28 days. Since it’s much harder to confirm breast cancer within 28 days than to rule it out, NHSE should publish the breast cancer diagnosis pathway and help services put it into practice.