Scottish referral guidelines for suspected cancer: quick reference guide

Lump

Any new discrete lump in patients 30 years and over

New asymmetrical nodularity that persists at review after two to three weeks (in patients over 35 years)

Unilateral isolated axillary lymph node in women persisting at review after two to three weeks

Recurrent lump at the site of a previously aspirated cyst

Nipple Symptoms

Visibly bloodstained discharge

New unilateral nipple retraction

Nipple eczema if unresponsive to moderately potent topical steroids after a minimum of two weeks

Skin changes

Skin tethering

Fixation

Ulceration

Peau d’orange

Abscess/infection

Mastitis or breast inflammation which does not settle or recurs after one course of antibiotics

Routine
referral

Primary care management - issue relevant advice leaflet (if available)

Lump

Any new discrete lump in patients under 30 years with no other suspicious features

New asymmetrical nodularity that persists at review after two to three weeks (in patients under 35 years)

Women with longstanding tender lumpy breasts and no focal lesion

Tender developing breasts in adolescents

Nipple Symptoms

Persistent unilateral spontaneous discharge sufficient to stain outer clothes

Transient nipple discharge which is not bloodstained

Check prolactin levels in persistent bilateral discharge

Longstanding nipple retraction

Nipple eczema if eczema present elsewhere

Skin changes

Obvious simple skin lesions such as epidermoid (sebaceous) cysts

Abscess/infection

Abscess or inflammation - try one course of antibiotics as per local guidelines

Any acute abscess requires immediate discussion with secondary care

Breast pain

Unilateral pain persisting over three months in
post-menopausal women

Intractable pain that interferes with the person’s lifestyle or sleep

Women with moderate degrees of breast pain and no discrete palpable lesion

Gynaecomastia

Exceptional aesthetics referral to plastic surgery pathway if appropriate (i.e. NOT to the breast service)

Exclude or treat any endocrine cause prior to referral

Examine and exclude abnormalities such as lymphadenopathy or evidence of endocrine condition with blood tests as per local guidelines.

Review to exclude drug causes

Breast implants

If appropriate, refer to the service that first inserted the implant (usually plastic surgery)

Reassurance is often appropriate if symptoms relate to the implant alone and not to underlying breast tissue