I was concerned to read the letter by Dr Shirley Holton and colleagues (20 May) concerning the two-week waiting target for cancers. While the promised referral guidelines have not been forthcoming from the NHS Executive, the information required for breast cancer is quite explicit.

The health service circular reiterates the key issues that the two-week rule will apply to patients first with suspected cancer and second where the GP requests an urgent appointment.

This definition may well exclude many of the patients identified in Dr Holton's letter, which records patients 'with a possible cancer diagnosis'.

I am concerned that the feared overload in achieving the two-week wait depends largely on making sure all parties stick to the set criteria. The number where the GP genuinely suspected cancer and was prepared to fax that to their cancer clinic would be fewer than the number of patients with 'a possible cancer diagnosis'.

This will become a major issue for cancer care over the coming year as the two-week rule moves from breast cancer to all other cancers. Clarity of definition at the outset is important, therefore, to make this process as painless as possible.

James W Rimmer

Project manager

Avon, Somerset and Wiltshire Cancer Services