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Breast – benign and malignant

Minimum referral criteria

Category 1 - Seen within 30 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 fine-needle aspiration cytology
  • 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
    • Ductal papilloma
    • Cyst persistently refilling or recurrent cyst
    • New lump during pregnancy
  • Breast pain:
    • Continuous mastalgia
    • Localised areas of painful nodularity or focal lesions.
  • Nipple discharge, nipple retraction, change in skin contour:
    • Discharge sufficient to stain clothes.
    • Blood-stained discharge.
    • Persistent single duct.
    • Nipple retraction or distortion.
    • Nipple eczema.
    • Paget's disease of the nipple.

Category 2 - Seen within 90 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 - Seen within 365 days

  • Gynaecomastia
  • Prophylactic mastectomy

Standard information for all referrals

Reason for request

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

Patient's demographic details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Phone contact numbers – 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 Torres Strait Islander Ask the patient their ethnicity

Referring practitioner details

  • Full name
  • Full address
  • Contact details – phone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Patient's usual general practitioner (if different from above)

Relevant clinical information about the condition

  • Inclusion of Clinical Prioritisation Criteria (CPC) where relevant
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Investigations carried out and results as indicated in the relevant pathway
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Options already pursued
  • 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

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 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, WorkCover, motor vehicle insurance)

Essential information

  • Document details or duration symptoms
  • Document family history of breast cancer
  • Description of clinical findings
  • Medical management to date
  • Current ultrasound and mammography results
  • Current fine-needle aspiration cytology or core biopsy results
  • Any previous relevant investigation results
  • Gynaecomastia require BMI

Additional information

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

Information for your patient

Expected time frame for appointment notifications

  • Once the request is received, categorisation by the hospital will occur.
  • General practitioners and patients are notified of the assigned category between 14 days to 1 month after completed request is received.
  • Patients are usually notified of the upcoming appointment time and date approximately 4 weeks prior unless short notice appointments become available.

Appointment information

  • Patients will be given an appointment via phone, SMS, or letter.
  • The patient must contact the hospital to reschedule if they are not able to attend.
  • If the patient fails to respond to 2 appointment offers:
    • They will be discharged back to their general practitioner.
    • They can have a new request for assessment sent to the hospital if the need still exists.
  • The patient's first appointment may not always be with a specialist. Where appropriate, the request may be sent to a public allied health or nursing service for initial assessment and management. A specialist assessment may then be arranged or ruled out.

Ask your patient to:

  • take a list of current medications, and all relevant radiology films and reports to appointments.
  • advise of any change in circumstance (e.g., getting worse or becoming pregnant), as this may affect the request for assessment.
  • update their contact details (e.g., phone number and address) with the hospital.
Last updated: 24 January 2020

Send referral

Specialist Outpatient Department

Fax: 1300 017 155

CQ Fracture/urgent referrals
Fax: (07) 4920 7242

Named referrals

If you would like to send a named referral, please address it to a specialist listed below.

Rockhampton

  • Dr Garry Dyke, Department Director
  • Dr Katarzyna Zalewska
  • Dr Chitrakanti Kapadia
  • Dr Yiu Ming Ho
  • Dr Michael Lamparelli

Gladstone

  • Dr Maseelan Naidoo
  • Dr Darren Lituri
  • Dr Robert Schreiber

Emerald

  • Dr Garry Dyke, Department Director
  • Dr Katarzyna Zalewska
  • Dr Chitrakanti Kapadia
  • Dr Yiu Ming Ho

> view all CQ Health specialists

Service advice

Rockhampton
Phone: (07) 4920 6440

Gladstone
Phone: (07) 4976 3169

Emerald
Phone: (07) 4987 9750

Biloela
Phone: (07) 4992 7000

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