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Breast - benign and malignant

Useful management information

  • USS both breast if:
    • <35 years old with:
      • breast lump or thickening or axillary mass
      • if a localised abnormality or suspicious lesion proceed to FNAB or > core biopsy
  • Bilateral mammogram and USS if:
    • >35 years old with significant breast symptoms or significant clinical findings
  • Discuss lifestyle modification for cancer reduction risk (increased activity, dietary, weight, smoking, alcohol)
  • Consider referral to Geneticist for familial genetic screening if appropriate
  • Consider the Familial Breast Cancer Clinic (PAH only) for high risk patients
  • Aboriginal and/or Torres Strait Islander people support services for breast cancer are available.

Clinical Resources

Minimum referral criteria (Does your patient meet the minimum criteria?)

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Diagnosed breast cancer:
    • early (confined to breast)
    • locally advanced (spread to involve areas near the breast)
    • secondary spread (involving areas outside the breast e.g. lymph nodes)
  • Inflammatory breast cancer (rare, involves lymphatic spread causing inflammation in the breast)
  • Recurrent breast malignancy
  • Suspicious lesion on breast screening mammography or FNAC
  • Suspicious breast mass on clinical examination
  • Ductal carcinoma-in-situ (non-invasive confined to the ducts)
  • Lobular carcinoma-in-situ (non-invasive confined to the lobules)

Breast lump

  • New diagnosis or clinically suspicious of primary breast malignancy (biopsy or mammogram proven)
  • New discrete firm lump
  • Young women with tender, lumpy breasts
  • Asymmetrical nodules that persist at review after menstruation
  • Older women with symmetrical nodules provided that they have no localised abnormality
  • Any lump that increases in size
  • Ductal papilloma
  • Cyst persistently refilling or recurrent cyst
  • New lump during pregnancy

Breast pain

  • Continuous mastalgia
  • Localised areas of painful nodularity/focal lesions

Nipple discharge, nipple retraction, change in skin contour

  • Discharge sufficient to stain clothes
  • Blood stained discharge
  • Persistent single duct
  • Nipple retraction/distortion
  • Nipple eczema
  • Paget's disease of the nipple
Category 2
(appointment within 90 calendar days)
  • Benign breast disease for consultation
  • Low-risk breast lumps/cysts
  • Patient referred for screening for breast malignancy or prophylactic mastectomy
  • Nipple discharge (non-blood stained)
  • Ductal papilloma
  • Fibroadenoma (diagnostic excision biopsy if diagnostic uncertainty)
  • Intermittent mastalgia i.e hormonal
  • Gynaecomastia where there is substantial breast enlargement or significant breast tenderness and where breast size is disproportionate to body habitus
Category 3
(appointment within 365 calendar days)
  • Gynaecomastia
  • Prophylactic mastectomy

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Breast - benign and malignant referrals (Referral will be returned without this)

  • Document details/duration symptoms
  • Document family history of breast cancer
  • Description of clinical findings
  • Medical management to date
  • Current USS/mammography results
  • Current FNAC or core biopsy results
  • BMI (For Gynaecomastia only)
  • Any previous relevant investigation results (if applicable)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Breast - benign and malignant referrals

  • Staging investigations e.g. Bone Scan and CT scan

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 5 February 2024