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Breast – benign and malignant


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

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

Last updated: 13 June 2023