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Breast cancer - suspected - Management
Specific recommendations
- A woman's first suspicion that she may have breast cancer is often when she finds a lump in her breast. The primary healthcare professional should examine the lump with the patient's consent. The features of a lump that should make the primary healthcare professional strongly suspect cancer are a discrete, hard lump with fixation, with or without skin tethering. In patients presenting in this way an urgent referral should be made, irrespective of age (C).
- In a woman 30 years of age and older with a discrete lump that persists after her next period, or presents after menopause, an urgent referral should be made (C).
- Breast cancer in women younger than 30 years of age is rare, but does occur. Benign lumps (for example, fibroadenoma) are common, however, and a policy of referring these women urgently would not be appropriate; instead, non-urgent referral should be considered. However, an urgent referral should be made in women younger than 30 years of age:
- With a lump that enlarges, (C) or
- With a lump that has other features associated with cancer (fixed and hard), (C) or
- In whom there are other reasons for concern such as family history** (D)
- The patient's history should always be taken into account. For example, it may be appropriate, in discussion with a specialist, to agree referral within a few days in patients reporting a lump or other symptom that has been present for several months (D).
- In a patient who has previously had histologically confirmed breast cancer, who presents with a further lump or suspicious symptoms, an urgent referral should be made, irrespective of age (C).
- In patients presenting with unilateral eczematous skin or nipple change that does not respond to topical treatment, or with nipple distortion of recent onset, an urgent referral should be made (C).
- In patients presenting with spontaneous unilateral bloody nipple discharge, an urgent referral should be made (C).
- Breast cancer in men is rare and is particularly rare in men under 50 years of age. However, in a man 50 years of age and older with a unilateral, firm subareolar mass with or without nipple distortion or associated skin changes, an urgent referral should be made (C).
**See NICE guideline on Familial breast cancer: the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care (http://guidance.nice.org.uk/CG41) [NICE, 2006].
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