Breast symptoms are a relatively uncommon presentation in primary care. It is estimated that between 0.35% and 0.6% of all consultations in Scotland are for breast symptoms. Many of these consultations will be in young women, whereas the biggest risk factor, after gender, is increasing age. Incidence of breast cancer in women aged 30-35 is 33 per 100,000 population and approximately 81% of breast cancers occur in women over the age of 50.<\/p>\n
Breast cancer accounts for 30% of cancers in women and around 4,400 people are diagnosed with breast cancer in Scotland each year; approximately 20 of these are men. The following recommendations seek to improve the referral and effective management of breast symptoms in women and men in primary care. Guidance for referral to regional genetics centres for those with a family history of breast cancer is available at Health Improvement Scotland website<\/a>.<\/p>\n\n
| <\/td> | Urgent suspicion of cancer referral<\/th> | Routine Referral<\/th> | Primary care management \nIssue relevant advice leaflet <\/th>\n<\/tr>\n<\/thead>\n |
|---|---|---|---|
| Lump<\/td> | Any new discrete lump (in patients over 35 years) \nNew asymmetrical nodularity that persists at review after menstruation (in patients over 35 years) \nUnilateral isolated axillary lymph node in women \nCyst persistently refilling or recurrent cyst <\/td> | Any new discrete lump in patients under 35 years with no other suspicious features \nNew asymmetrical nodularity that persists at review after menstruation (in patients under 35 years) <\/td> | Women with longstanding tender lumpy breast and no focal lesion \nTender developing breasts in adolescents <\/td>\n<\/tr>\n |
| Nipple symptoms<\/td> | Bloodstained discharge \nNew nipple retraction \nNipple eczema if unresponsive to topical steroids (such as 1% hydrocortisone) after a minimum of 2 weeks <\/td> | Persistent discharge sufficient to stain outer clothes <\/td> | Transient nipple discharge which is not bloodstained \nCheck prolactin levels when discharge present \nLongstanding nipple retraction \nNipple eczema if eczema present elsewhere <\/td>\n<\/tr>\n |
| Skin Changes<\/td> | Skin tethering \nFixation \nUlceration \nPeau d'orange<\/td> | <\/td> | Obvious simple skin lesions such as sebaceous cysts <\/td>\n<\/tr>\n |
| Abscess\/infection<\/td> | Mastitis or breast inflammation which does not settle after one course of antibiotics <\/td> | Abscess or breast inflammation even after settled in patients over 35 years <\/td> | Abscess* or inflammation - try one course of antibiotics to cover staphylococcus and streptococcus (also consider possible anaerobic infection as per local guidelines) <\/td>\n<\/tr>\n |
| Pain<\/td> | <\/td> | Unilateral persistent pain in post menopausal women \nIntractable pain that interferes with the patient's lifestyle or sleep <\/td> | Women with moderate degrees of breast pain and no discrete palpable lesion <\/td>\n<\/tr>\n |
| Gynaecomastia<\/td> | <\/td> | Exceptional aesthetics referral to plastic surgery pathway if required \nExclude or treat any endocrine cause prior to referral <\/td> | Examine and exclude abnormalities such as lymphadenopathy or evidence of endocrine condition \nReview to exclude drug causes \nMeasure hormones (oestrogen, testosterone, prolactin, human chorionic gonadotropin and alpha-fetoprotein) \nReassure <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n * Any acute abscess requires immediate discussion with secondary care.<\/em><\/p>\n Reference:<\/em> |