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Should I see a breast cancer specialist?

Men and women discussing breast cancer

This page tells you about the guidelines that GPs in the UK have. The guidelines help them to refer women appropriately for breast cancer tests. There is information below about

 

A quick guide to what's on this page

Who should see a specialist?

It can be very difficult for GPs to decide who may have a breast cancer and who may have a non cancerous breast condition. But there are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs to help them decide which patients need to be seen quickly by a specialist. You should ideally get an appointment within 2 weeks. 

NICE say that the symptoms that could be due to breast cancer are

  • A fixed, hard lump in the breast at any age
  • A lump in women aged 30 or over that is still there after their next period
  • A lump that appears in a woman after menopause
  • A lump in a woman under 30 that is getting bigger, is fixed and hard, or there are other reasons for concern, such as a strong family history of breast cancer
  • A lump or other suspicious symptoms in anyone who has had breast cancer before
  • A rash on one nipple or in the surrounding area (this is very rare), that has not responded to treatment
  • Nipples that have turned in (inverted) recently
  • A discharge from the nipple for no apparent reason
  • A firm lump under one nipple, with or without changes in the nipple shape or to the surrounding skin in men aged 50 or over

A symptom such as a distinct lump in a woman under 30 is not likely to be a breast cancer but the woman should be referred to a specialist.

 

CR PDF Icon You can view and print the quick guides for all the pages in the About breast cancer section.

 

 

The NICE guidelines

It can be very difficult for GPs to decide who may have a breast cancer and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

A GP with 2,000 patients is likely to see only one woman a year who has breast cancer. But they will see a lot more women who have non cancerous breast conditions such as

  • Cysts – sacs of fluid in the breast tissue (most common in women between 40 to 60 years)
  • Fibroadenomas – collections of fibrous glandular tissue (most common in the 20 to 30 age group)
  • Diffuse nodularity (lumpy breasts) – which are common in all age groups up to 50
  • Breast pain – this is not a usual symptom of breast cancer

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs to help them to decide which patients need to be seen quickly by a specialist. 

 

Symptoms that could be due to breast cancer

According to the NICE guidelines, you should ideally get an appointment within 2 weeks if you have symptoms that could be due to breast cancer. The symptoms include

  • A fixed, hard lump in the breast at any age
  • A lump in women aged 30 or over that is still there after their next period
  • A lump that appears in a woman after menopause
  • A lump in a woman under 30 that is getting bigger, is fixed and hard, or there are other reasons for concern, such as a strong family history of breast cancer
  • A lump or other suspicious symptoms in anyone who has had breast cancer before
  • A rash on one nipple or in the surrounding area (this is very rare), that has not responded to treatment
  • Nipples that have turned in (inverted) recently
  • A discharge from the nipple for no apparent reason
  • A firm lump under one nipple, with or without changes in the nipple shape or to the surrounding skin in men aged 50 or over

It is important to remember that these symptoms may be due to conditions other than breast cancer.

 

Symptoms that are unlikely to be a cancer

If you have the following symptoms they are unlikely to be due to breast cancer but your doctor may refer you to a breast clinic.

  • A distinct lump in women under 30
  • Breast pain (with no lump) that does not go away with reassurance, wearing a well supporting bra, or painkillers prescribed by your GP
  • Lumpy breasts that do not go away after your period has finished
  • A sore infected area on the breast (called an abscess)
  • Sacs of fluid (cysts) in the breast tissue that keep filling up or coming back after treatment
  • Any woman under 50 who has a blood stained discharge or a discharge from both nipples that is enough to stain clothing
 

Symptoms that can be managed by the GP

There are certain sets of symptoms that are very unlikely to be cancer. The guidelines say these are

  • Young women who have tender, lumpy breasts
  • Older women with breasts that are similarly lumpy on both sides
  • Minor or moderate breast pain with no lump
  • Women with a minor family history of breast cancer and no symptoms

It is very common for women to have tender, lumpy breasts in their 20s, 30s and 40s. The lumpiness is most common before a period. If your breasts are equally lumpy on both sides and the lumps come and go, this isn't likely to be cancer.

Bear in mind that the risk of getting breast cancer gets higher as you get older. Only 5 out of every 100 women (5%) diagnosed with breast cancer are under 40. Only 2 out of every 100 breast cancers (2%) are diagnosed in women under 35.

Unfortunately though, in younger women it is more likely that a breast cancer diagnosis will be delayed, simply because it is more unusual. If you have a symptom listed here as urgent and you are worried that your GP isn't taking it seriously, you could print this page and take it to an appointment. Ask your GP to talk it through with you. Then you may be able to decide together whether you need to see a specialist and if so, how soon.

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Updated: 30 July 2014