All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Referral
Breast
Scope
This guidance covers the referral of a patient who presents with symptoms suggestive of breast cancer to a team specialising in the management of breast cancer.
GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.
Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.
Investigations in patients presenting with symptoms and/or signs suggestive of breast cancer, investigation prior to referral is not recommended.
In general:
- convey optimism about the effectiveness of breast cancer treatments and survival of breast cancer patients
- discuss the information and support needs of your patient and respond sensitively
- encourage all patients, including women over 50 years old, to be breast aware
Always take the patient's history into account. For example, it may be appropriate, in discussion with a specialist, to agree referral within a few days in a patient who reports a lump or other symptom that has been present for several months.
Referral Criteria
Suspected Cancer referral
- Aged 30 and over with an unexplained breast lump with or without pain
- Aged 50 and over with any of the following symptoms in one nipple only
- Discharge (spontaneous clear or bloody)
- Retraction (new onset and distortion ???)
- Skin changes of concern (e.g. males over 50 with unilateral firm subareolar mass with or without nipple distortion or skin changes
Consider Suspected Cancer referral
- Aged over 30 with unexplained lump in the axilla and have skin changes that suggest breast cancer
A non-urgent referral should be considered in:
- Aged under 30 with an unexplained breast lump with or without pain
- Women aged younger than 30 years with a lump
- Patients with breast pain and no palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms. (Use of mammography in these patients is not recommended)
Referral Instructions
The GP should use e-Referral Service to book the appointment or send the referral
Please ensure you include:
- The patient's NHS number
- Tell the patient that this is an urgent referral and they will be seen within 14 days
Suspected cancer referral
e-Referral selection:
- Priority: 2WW
- Specialty: 2WW
- Clinic type: 2WW Breast
- Service: Two Week Wait Breast -RDE-RH8
Cancer not suspected referral
e-Referral selection:
- Priority: 2WW
- Specialty: Surgery - Breast
- Clinic type: Other symptomatic Breast
- Service: Symptomatic Breast (cancer not suspected) – RD&E-RH8
Please ensure that referrals are booked via NHS e-Referral Service. If no slots are available please defer to provider and the RDE will book the appointment and contact the patient. Please also ensure that referral letters are attached to the system within 24 hours to enable us to book pre appointment tests and scans timely.
For any patients that you are unable to process through NHS e-Referral please contact the drss.helpdesk@nhs.net.
Referral Forms
Suspected Breast Cancer referral form - No merge fields
Evidence
NICE referral guidelines for suspected cancer
GP Information
Suspected Cancer Guidelines A-Z
NICE referral guidelines for suspected cancer
bmj - New NICE guidance on referral for cancer
bmj - Assessing and referring adult cancers infographic
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Patient Information
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Pathway Group
This guideline has been signed off by NHS Devon
Publication date: November 2016
