Key points
- Symptomatic patients should be referred to a breast clinic for assessment.
- Referrals for a high suspicion of cancer should be marked as such, to ensure they can access the Faster Cancer Treatment programme
Concerning breast changes
If a patient presents with concerning breast changes, they should be assessed by their GP to determine if they need to be referred for breast cancer assessment or management of a benign condition.
Referrals for high suspicion of cancer should be marked as such; this facilitates access to the Faster Cancer Treatment programme. Requests for assessment related to high suspicion of cancer must:
- Be made via eReferral (if available) to the relevant service. However, faxes are accepted if eReferral is not available.
- Have “high suspicion of cancer”, clearly annotated at the top of the referral.
- Address each of the clinical triage criteria defined in the relevant pathway, to enable accurate triage by the consultant.
If patients are referred under high suspicion of cancer, consider referring them to Cancer Support Services. If the patient needs assistance (i.e. travel assistance) to attend their first specialist appointment, contact a cancer nurse coordinator for advice.
Patients who have a lower index of suspicion should be referred for specialist assessment as usual. The normal prioritisation process applies for these cases.
Criteria for high suspicion of breast cancer
The Ministry of Health criteria is used to determine or confirm the ‘high suspicion of cancer’ flag.
- Diagnosed cancer on fine needle aspiration or core biopsy (or results suspicious of malignancy).
- Imaging suspicious of malignancy.
- Discrete, hard breast lump with fixation (with or without skin tethering).
- Discrete breast lump that presents in women:
- aged 40 years or older, and persists after her next period or presents after menopause
- younger than 40 years and the lump is increasing in size or where there are other reasons for concern, such as strong family history
- with previous breast cancer or ovarian cancer.
- Suspected inflammatory breast cancer or symptoms of breast inflammation that have not responded to a course of antibiotics.
- Spontaneous unilateral bloody nipple discharge.
- Women aged 40 years or older with:
- recent onset unilateral nipple retraction or distortion
- unilateral eczematous skin or nipple change that does not respond to topical treatment.
- Men aged 50 years or older with a unilateral, firm subareolar mass, which is not typical gynaecomastia or is eccentric to the nipple.
