We thank Dr Twoon et al for their article on management of a breast lump in general practice.
However, we would like to clarify their advice to refer patients with red flag breast symptoms or abnormal changes to a breast clinic "for triple assessment". Referral to a breast clinic is for a specialist opinion, which may or may not include triple assessment. As Mr Barber acknowledges in his response, triple assessment is simple in the case of a discrete breast lump. The spectrum of breast symptoms including 'abnormal changes' and 'red flag' symptoms is a wide one, and clinical examination at the breast clinic may be all that is indicated, without need for imaging or biopsy.
Referral of patients with breast symptoms other than a discrete lump may well be entirely appropriate, but it is important not to give patients the expectation of triple assessment in every case.
Competing interests:
No competing interests
02 October 2014
Jennifer McIlhenny
Specialty Registrar 7 in General and Breast Surgert
Katherine Krupa, Consultant Breast and General Surgeon, Royal Alexandra Hospital, Paisley
NHS Greater Glasgow and Clyde
Department of Breast Surgery, Royal Alexandra Hospital, Corsebar Rd, Paisley, PA2 9PN
Rapid Response:
We thank Dr Twoon et al for their article on management of a breast lump in general practice.
However, we would like to clarify their advice to refer patients with red flag breast symptoms or abnormal changes to a breast clinic "for triple assessment". Referral to a breast clinic is for a specialist opinion, which may or may not include triple assessment. As Mr Barber acknowledges in his response, triple assessment is simple in the case of a discrete breast lump. The spectrum of breast symptoms including 'abnormal changes' and 'red flag' symptoms is a wide one, and clinical examination at the breast clinic may be all that is indicated, without need for imaging or biopsy.
Referral of patients with breast symptoms other than a discrete lump may well be entirely appropriate, but it is important not to give patients the expectation of triple assessment in every case.
Competing interests: No competing interests