The issue determining if a patient should be referred to a specialist breast clinic is whether the general practitioner can adequately reassure the patient that they do not have a remediable breast problem, notably a breast cancer. With a lump this is simple. Such reassurance requires triple assessment (clinical, imaging and biopsy) and the patient should be referred. Features from the history such as character of lump, family history or endocrine exposure may be epidemiologically interesting but are of no use in determining the cause of a lump. Information on comorbidity, drug and social history are of more practical value.
The wider problem is a combination of 1)the apparent lack of confidence in breast assessment by GPs (who receive 2 days of undergraduate breast teaching locally) and 2) patient anxiety, in part driven by charity, media and government-sponsored awareness campaigns (which have yet to have been shown to produce an increase in breast cancer diagnosis). This has contributed to an increase in referrals to the specialist breast clinic in Edinburgh of around 4% per year while symptomatic cancer diagnosis has increased by about 2% per year. Currently about 1 in 19 patients referred to our specialist breast clinic has breast cancer. Most patients with breast pain and skin lesions should not need to be seen at a specialist breast clinic but again, this requires the GP to be confident to adequately assess and reassure the patient who is often programmed to seek specialist referral.
General practitioners lacking confidence in clinical assessment of the breast are encouraged to get in touch with their local breast unit and arrange to join us for a few clinics.
Rapid Response:
The issue determining if a patient should be referred to a specialist breast clinic is whether the general practitioner can adequately reassure the patient that they do not have a remediable breast problem, notably a breast cancer. With a lump this is simple. Such reassurance requires triple assessment (clinical, imaging and biopsy) and the patient should be referred. Features from the history such as character of lump, family history or endocrine exposure may be epidemiologically interesting but are of no use in determining the cause of a lump. Information on comorbidity, drug and social history are of more practical value.
The wider problem is a combination of 1)the apparent lack of confidence in breast assessment by GPs (who receive 2 days of undergraduate breast teaching locally) and 2) patient anxiety, in part driven by charity, media and government-sponsored awareness campaigns (which have yet to have been shown to produce an increase in breast cancer diagnosis). This has contributed to an increase in referrals to the specialist breast clinic in Edinburgh of around 4% per year while symptomatic cancer diagnosis has increased by about 2% per year. Currently about 1 in 19 patients referred to our specialist breast clinic has breast cancer. Most patients with breast pain and skin lesions should not need to be seen at a specialist breast clinic but again, this requires the GP to be confident to adequately assess and reassure the patient who is often programmed to seek specialist referral.
General practitioners lacking confidence in clinical assessment of the breast are encouraged to get in touch with their local breast unit and arrange to join us for a few clinics.
Competing interests: No competing interests