Breast – benign and malignant

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Suspected strangulated/incarcerated or obstruction of any hernia
    • Acute, severe abdominal pain with or without associated sepsis
    • New onset of obstructive jaundice
    • Acute painful perianal conditions
    • Acute cholecystitis
    • Gallstones with symptoms of cholangitis
    • Acute pancreatitis
    • Bowel obstruction
    • Severe per rectum bleeding
    • Acute abscess at any site
    • Acute testicular pain
    • Refer to HealthPathways or local guidelines
    • USS both breast if:
      • <35 years old with:
        • breast lump or thickening or axillary mass
        • if a localised abnormality or suspicious lesion proceed to FNAB or core biopsy
    • Bilateral mammogram and USS if:
      • >35 years old with significant breast symptoms or significant clinical findings
    • Consider referral to Geneticist for familial genetic screening if appropriate
    • Discuss lifestyle modifications for cancer reduction risk (increased activity, dietary, weight, smoking, alcohol)
    • Aboriginal and/or Torres Strait Islander people support services for breast cancer are available
    • Best practice information on breast cancer 
    • GP guides and resources for breast cancer
    • Cancer risk reduction
    • Check Your Cancer Risk, iPrevent
    • Information on genetic testing
    • The BreastScreen program – 50-74 years – is funded to investigate asymptomatic patients only to the point of clear diagnosis (accepts woman in their 40s or 75 years and over).

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

  • Diagnosed breast cancer:
    • early (confined to breast)
    • locally advanced (spread to involve areas near the breast)
    • secondary spread (involving areas outside the breast e.g. lymph node
  • Inflammatory breast cancer (rare, involves lymphatic spread causing inflammation in the breast)
  • Recurrent breast malignancy
  • Suspicious lesion on breast screening mammography or FNAC
  • Suspicious breast mass on clinical examination
  • Ductal carcinoma-in-situ (non-invasive confined to the ducts)
  • Lobular carcinoma-in-situ (non-invasive confined to lobules)

    Breast lump

  • New diagnosis or clinically suspicious of primary breast malignancy (biopsy or mammogram proven)
  • New discrete lump
  • Young women with tender, lumpy breasts
  • Asymmetrical nodules that persist at review after menstruation
  • Older women with symmetrical nodules provided that they have no localised abnormality
  • Any lump that increases in size
  • Cyst persistently refilling or recurrent cyst
  • New lump during pregnancy

  • Breast pain

  • Continuous mastalgia
  • Localised areas of painful nodularity/ focal lesions

    Nipple discharge, nipple retraction, change in skin contour

  • Discharge sufficient to stain clothes
  • Blood stained discharge
  • Persistent single duct
  • Nipple retraction/distortion
  • Nipple eczema
  • Paget's disease of the nipple
Category 2
(appointment within 90 calendar days)
  • Benign breast disease for consultation
  • Low-risk breast lumps/cysts
  • Patient referred for screening for breast malignancy
  • Nipple discharge (non-blood stained)
  • Ductal papilloma
  • Fibroadenoma (diagnostic excision biopsy if diagnostic uncertainty)
  • Intermittent mastalgia i.e. hormonal
  • Gynaecomastia where there is substantial breast enlargement or significant breast tenderness and where breast size is disproportionate to body habitus
Category 3
(appointment within 365 calendar days)
  • Gynaecomastia
  • Prophylactic mastectomy
  • Breast reduction

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Document details/duration symptoms
  • Document family history of breast cancer
  • Description of clinical findings
  • Medical management to date
  • Current USS/mammography results
  • Current FNAC or core biopsy results
  • Any previous relevant investigation results
  • Gynaecomastia require BMI

3. Additional referral information Useful for processing the referral

  • Staging investigations e.g. Bone scan, CT scan

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 17 September 2020

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