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Breast Lumps And Suspected Breast Cancer (Female)



This guideline applies to women over 18 years.

 

Introduction

 

  • 1 in 8 women in the UK will develop breast cancer at some time
     
  • 9 out of 10 women who develop breast cancer do not have a family history of breast cancer
     
  • The triple test (clinical examination, imaging and biopsy) will detect over 99.6% of breast cancers. In patients under 40 years imaging is usually an USS rather than a mammogram

 

 

Red flags

  • Breast implant-associated anaplastic large cell lymphoma
     
  • Previous breast cancer
     
  • Significant family history of breast or ovarian cancer
     
  • Signs and symptoms suggestive of breast cancer:
    • Unexplained discrete breast or axillary lump, ulceration, skin dimpling, breast distortion.
    • Bloody or serous unilateral nipple discharge
    • Persistent nipple eczema, nipple ulceration, new nipple retraction/distortion
    • Breast infection or inflammation that fails to respond to antibiotics.
    • New asymmetric nodularity persisting after menstruation or for 2-3 weeks.
    • Non-lactational mastitis >50yrs or mastitis which fails to respond to antibiotics.

 

 

Key Features of Assessment

 

History:

In addition to usual breast symptom history:

  • If implants – ask about unexplained breast enlargement, asymmetry, fluid build-up (see breast implants), whether saline or silicone and whether a PIP implant was used
     
  • Previous breast disease/investigations
     
  • Most recent mammogram (offered to all women aged 50-71yrs every 3 yrs)
     
  • Risk factors – obesity, Ashkenazi Jewish ancestry, chest wall radiation, smoking, excess alcohol
     
  • Family history: breast/ovarian cancer (see Familial Breast and Ovarian Cancer), sarcoma under 45yrs, complicated multiple cancers at a young age, glioma or childhood adrenal carcinomas

 

 

Management

 

Asymmetric nodularity (any age) or breast lump under 30yrs:

Re-examine after their next menstruation or in 2-3 weeks.

 

 

Advice and Guidance

 

There is no advice and guidance service for breast surgery.

 

 

Referral

 

2ww criteria: (Patients seen in 4 hour one-stop clinic with imaging)

Female patients:

  • 30yrs+ with an unexplained discrete breast or axillary lump
     
  • Skin changes that suggest breast ca. e.g. skin tethering, contour change, or peau d’orange.
     
  • 50yrs+ with unilateral nipple discharge, inversion, retraction, ulceration, or other changes of concern.
     
  • 50yrs+ years with non-lactational mastitis
     
  • Any age with breast infection or inflammation that fails to respond to antibiotics.

 

Symptomatic Breast Clinic criteria (refer using suspected cancer form): (patients usually seen within 4-6 /52 in shorter clinic and imaging may be done at a later appointment)

  • <30yrs with unexplained discrete breast lump
     
  • Persistent asymmetrical nodularity
     
  • Nipple rash with no associated symptoms persisting after 2/52 of treatment.
     
  • Persistent nipple discharge
     
  • Breast pain with no red flags and no response to conservative measures after 6 weeks
     
  • Breast implant complications: change in breast size, fluid build-up, or swelling around implant, suspected implant rupture/capsule formation or PIP implant.
     
  • If patient requires follow-up, specialist nurse support or prosthesis-fitting support following breast cancer (e.g. recently moved to the area)

 

 

 

Supporting Information

 

For professionals:

 

For patients:

 

 

Page Review Information

 

Review date

12 January 2024

Next review date

12 January 2026

Clinical editor

Dr Madeleine Attridge

Contributors

 

 

Mr Iain Brown (Consultant Breast surgeon)

Miss Polly King (consultant Breast surgeon)

Dr Rebecca Osborne (GPwSI Breast)