Referral Guidelines For General Practitioners For Breast Diseases

Lumps

  • Any new lump that is discrete
  • A new lump (aka dominant lump) in an area of known nodularity
  • Asymmetrical nodularity that persists after a complete menstrual cycle
  • Abscess persisting or recurring after a single course of antibiotics
  • Lymph nodes in the axilla or supraclavicular fossa

Pain

  • Pain associated with a lump
  • Persistent pain not responding to reassurance, simple measures such as well fitting bra, evening primrose oil
  • Persistent unilateral pain in a postmenopausal woman

Nipple discharge

  • Blood stained nipple discharge at any age
  • Persistent discharge of any colour from a single duct
  • Persistent bilateral nipple discharge

Nipple discharge

  • Blood stained nipple discharge at any age
  • Persistent discharge of any colour from a single duct
  • Persistent bilateral nipple discharge

Nipple retraction, distortion, eczema

  • Of recent onset
  • Associated with a lump

Skin changes

  • Dimpling
  • Peau de orange
  • Ulceration

Family history

(guidelines developed in association with local genetics center)

Family history of breast cancer Expected breast cancer cases between 40-50years Lifetime relative risk Risk category Early mammogram indicated? Refer to genetics clinic?
1 relative >40 years max. 1 in 50 max. 1 in 8 low no no
1 relative <40 years 1 in 30 to 1 in 50 1 in 12 to 1 in 6 low/moderate yes no
female < 30 or male at any age max. 1 in 25 1 in 8 low/moderate yes yes
2 relatives 50-60years 1 in 40 1 in 8 low no no
2 relatives average age 40-49 1 in 25 1 in 6 moderate yes yes
2 relatives av. age 30-39 1 in 14 1 in 4 high yes yes
3 relatives av.age 50-60 1 in 15 1 in 4 moderate yes yes
3 relatives av.age 40-50 1 in 11 1 in 3 high yes yes
1 or more relative with breast cancer <50 +1 or more relative with ovarian cancer at any age or one relative with both cancers >1 in 25 > 1 in 6 moderate/high yes yes
1 or more relative with breast cancer <40 + relative with childhood malignancy NA NA high under review yes

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