Breast Lumps And Suspected Breast Cancer (Female)
This guideline applies to women over 18 years.
Introduction
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1 in 8 women in the UK will develop breast cancer at some time
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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
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Breast implant-associated anaplastic large cell lymphoma
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Previous breast cancer
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Significant family history of breast or ovarian cancer
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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:
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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
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Previous breast disease/investigations
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Most recent mammogram (offered to all women aged 50-71yrs every 3 yrs)
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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:
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30yrs+ with an unexplained discrete breast or axillary lump
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Skin changes that suggest breast ca. e.g. skin tethering, contour change, or peau d’orange.
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50yrs+ with unilateral nipple discharge, inversion, retraction, ulceration, or other changes of concern.
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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)
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<30yrs with unexplained discrete breast lump
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Persistent asymmetrical nodularity
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Nipple rash with no associated symptoms persisting after 2/52 of treatment.
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Persistent nipple discharge
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Breast pain with no red flags and no response to conservative measures after 6 weeks
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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:
- NHS Royal Cornwall Hospitals – Breast Webinar 2022 [video: 1 hour 17 minutes]
- NICE: Clinical Knowledge Summaries (CKS) – Breast Cancer: Recognition and Referral
- NICE Guidance – Suspected Cancer: Recognition and Referral – Breast Cancer
For patients:
- Breast Cancer Now:
- CoppaFeel – Information and Resources
Page Review Information
Review date |
12 January 2024 |
Next review date |
12 January 2026 |
Clinical editor |
Dr Madeleine Attridge |
Contributors
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Mr Iain Brown (Consultant Breast surgeon) Miss Polly King (consultant Breast surgeon) Dr Rebecca Osborne (GPwSI Breast) |
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