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J R Soc Med. 2004 June; 97(6): 311.
PMCID: PMC1079516

Waiting times for cancer treatment

Sarah Duff and her colleagues (March 2004 JRSM1) report on the difficulties in meeting waiting time targets for treatment of colorectal cancer. An important cause of delay was shortage of staff and equipment for preoperative radiotherapy. Others have noted the contribution of delays before referral.2 The Government's targets are based on a belief, rather than scientific evidence, that earlier treatment will produce more cures. A scientific approach would consider not only the entire clinical course but also the phenomenon of ‘biological predeterminism’,3 whereby tumour behaviour is determined early in the pre-clinical phase. Indeed, ACPGBI guidelines4 on bowel cancer referral raise the question ‘whether early diagnosis in an anatomical sense can be achieved by earlier symptomatic diagnosis in the temporal or chronometric sense... ’.


1. Duff SE, Wood C, McCredie V, Levine E, Saunders MP, O'Dwyer ST. Waiting times for treatment of rectal cancer in North West England. J R Soc Med 2004;97: 117-18 [PMC free article] [PubMed]
2. Flashman K, O'Leary DP, Senapati A, Thompson MR. The Department of Health's ‘two week wait’ standard for bowel cancer: is it working? Gut 2004;53: 387-91 [PMC free article] [PubMed]
3. Macdonald I. Biological predeterminism in human cancer. Surg Gynaecol Obstet 1951;92: 443-52 [PubMed]
4. Referral Guidelines for Bowel Cancer [] accessed 21.4.04

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press