The benefits of fast treatment

Three days after she went to see her GP with a lump in her breast, Janice Millar had a scan in hospital. A consultant told her she had cancer the same afternoon and within a month she had undergone surgery.

Mrs Millar, 50, from Paisley, said: "At the time I didn't realise that I was any different, that the process could be faster or slower. My oldest son thought it should have been faster. He thought the minute I was diagnosed I should have been in."

Most of the women she met when she was receiving treatment had similar stories of swift attention. However, Ms Millar, a former nurse, said there were exceptions.

"I did know in other postcodes the time for GPs referring you even for a mammogram could take forever," she said. "It doesn't always present itself as a lump in your breast. Sometimes it can be a thickening in your lymph nodes."

Cancer, in its different forms, can certainly be furtive. Every year thousands of people with potential symptoms will be given the all clear while others, with little warning, will find out they have the disease. Breast cancer is actually relatively easy to spot and this is reflected in shorter waiting times for treatment.

An investigation by The Herald found the majority of patients began receiving chemotherapy or surgery within weeks of their GP referring them to hospital - even if their doctor had not marked their case as urgent.

Dr Bob Masterton, lead clinician with the West of Scotland Cancer Network, explained hospital specialists reviewed cases queueing for their clinics and upgraded any which they thought warranted quicker attention.

"We have looked at benign breast cancer clinics and the number of cancers picked up from them is extremely small," he said.

The latest available figures for some health board areas actually show non-urgent patients being treated more swiftly than urgent patients - perhaps reflecting the nature of the cases concerned. However, the average delay for treatment was 10 days longer for non-urgent referrals in Forth Valley last year and 12 days longer in Tayside.

Breast Cancer Care also pointed out the longest wait recorded for non-urgent referrals was 236 days, compared to 182 days among the urgent stream.

Anna Wood, policy and campaigns manager for the charity, said: "This is highly concerning for people who are not urgently referred to see a specialist and have to wait longer for their appointments.

"Breast Cancer Care believes it is essential to monitor and review the impact of the urgent/non-urgent referral classification of breast cancer to determine whether it is having any adverse impact on people receiving treatment for breast cancer."

Long delays for cancer treatment can be the result of decisions patients have taken themselves. Cathy Adamson, now 41, was first referred to hospital at 34 and had become very anaemic after having her first daughter.

She thought she was going to be seen by a dietician so was surprised to find herself in the colorectal unit being offered a colonoscopy. "I said, do not be ridiculous, I am not ill'," she recalled. "You have to bear in mind with a colonoscopy there is always a risk they can perforate the bowel. I think our generation are a wee bit more questioning of doctors and that can work in your favour, but it can also work totally against you."

Two-and-a-half years after this Mrs Adamson, from Edinburgh, had the investigation and discovered she had bowel cancer.

"I remember thinking I am not going to cry, I am not going to cry'," she said. Fortunately the tumour had not spread to her liver and, after surgery and gruelling chemotherapy, she began to recover. Then, last summer, secondary cancer in her left ovary was detected. She said: "I never thought that I might not live the first time. I just thought how lucky I was to have escaped and I didn't take it seriously. But boy did I take it seriously the second time."

Mrs Adamson, who had a major operation to remove the new tumour, believes the delay she caused to her initial diagnosis is linked to her cancer coming back.

"If you catch cancer early your chances of survival are much, much better," she said. "My message to young people is do not presume what you have or diagnose yourself."

The charity Bowel Cancer UK is concerned about survival rates in the UK saying they are behind Europe and America. Scotland has one of the highest rates of bowel cancer in the world, with more than 3400 new cases every year and about 1500 deaths annually.

Ian Beaumont, campaigns director for Bowel Cancer UK, said: "Bowel cancer is the most treatable cancer if caught early, yet it seems so difficult for patients to get seen early, treated early and to get the drugs they need."

Many people with bowel cancer display no symptoms until the later stages of the disease. However, bowel complaints are common and people with a whole range of conditions need to access the same hospital specialists and exploratory equipment. This situation causes such bottlenecks that treating urgent referrals in line with the Scottish Government's target has proved difficult.

The latest available data shows there are still urgent cases who do not receive surgery or therapy within the two-month time frame. This is more than a year after the goal should have been met.

However, The Herald discovered patients with bowel cancer who are not urgently referred to hospital have to wait even longer for treatment. Information about the delays they experience is not published in the same way as the data on urgent referrals, which is regularly updated.

Yet our research shows hundreds of people with cancer are hidden on this second waiting list.

Last year, GPs conducted an audit of their own referrals, identifying when people they labelled non-urgent did turn out to have cancer, in order to improve the way they classify patients.

However, Dr Stuart Scott, joint deputy chair of the British Medical Association's Scottish General Practitioners Committee, said this was not being continued on a national basis this year.

Mr Beaumont said: "The sheer number of people with non life-threatening conditions such as piles would overwhelm the system, but from our experience too many people with bowel cancer are missed."

Screening for the disease

Screening for bowel cancer is being introduced in phases across Scotland.

Pilots have already taken place in the north east, with doctors declaring the programme a success.

Under the scheme, patients aged 50 to 74 are invited to send away a stool sample which is then tested for traces of blood. Where there is a positive result, patients will be called in for further examination - usually a colonoscopy.

The scheme started in Tayside, Grampian and Fife in June. It is currently starting in Ayrshire and Arran and Orkney, and should begin in Forth Valley and the Lothians in December. It is due to commence in Greater Glasgow and Clyde in April 2009, reaching Lanarkshire in July that year and covering the whole of Scotland by the end of 2009.