Downgrading of referrals to breast cancer patient pathway.

Background: The purpose of the study was to investigate whether the downgrading of external referrals to breast cancer patient pathways was clinically justifiable and led to a more correct prioritisation of patients who are referred to the specialist health service.

Material And Method: The study included 214 external referrals to breast cancer patient pathways at the Breast Screening Centre, Oslo University Hospital, which were downgraded in 2020 since they did not meet the national criteria. The information obtained from electronic patient records included age, district of Oslo, name of referring doctor, outcome after investigation and treatment, as well as recommended timeframe for initiating the investigation. The quality of the referrals was also assessed.

Results: A total of 3 % (7/214) of patients were diagnosed with breast cancer. Five were in the age group 40-50 years (9 %, 5/56), one was over the age of 50 years (1/31) and one was in the age group 35-40 years (1/38). None were below the age of 35 years. A total of 95 doctors had their referrals downgraded.

Interpretation: The study indicated that the downgrading of referrals to breast cancer patient pathways led to a more correct prioritisation of patients who are referred to the specialist health service. The results indicated that the downgrading was clinically justifiable for the age groups under 35 years and over 50 years, but that caution must be exercised when downgrading referrals in the age group 40-50 years.