Breast 2WW

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.

“In the presence of a normal physical examination, simple breast pain is not associated with an increased risk of cancer. There is an excellent training resource via this link which is endorsed by all breast specialists in Devon and Cornwall. You can also read the joint statement on the management of breast pain issued by the association of breast surgery here.

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

Investigations in patients presenting with symptoms and/or signs suggestive of breast cancer, investigation prior to referral is not recommended.

Management

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

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: 2WW Breast Male - NDHCT - NDDH - RBZ/ 2WW Breast Surgery - NDHCT - NDDH - RBZ
Cancer not suspected referral

e-Referral selection:

  • Priority: Urgent
  • Specialty: Surgery - Breast
  • Clinic type: Other symptomatic Breast
  • Service: Breast Pain & Male patients –NDHCT–NDDH-RBZ

Please ensure that referrals are booked via NHS e-Referral Service. If no slots are available please defer to provider and the NDDH 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

Suspected Breast Cancer referral form - EMIS

Suspected Breast Cancer referral form - SystmOne

Last updated: 28-07-2023

 

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