Referral to a specialist

In England and Northern Ireland, your GP will arrange for you to see a specialist within 2 weeks if you have symptoms that could be due to breast cancer.

This 2 week time frame is not part of the waiting time targets for Scotland and Wales.  But wherever you live, you are seen as quickly as possible. 

How your GP decides

On average, GPs are likely to see about 1 to 2 women a year who have 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 women aged between 20 to 30)
• diffuse nodularity (lumpy breasts) – this is common in all age groups up to 50
• breast pain – this is not a usual symptom of breast cancer

It can be hard for GPs to decide who might have cancer and who might have a more minor condition. 

In the UK there are national guidelines that help GPs decide who they should refer to a specialist. There are some differences in the guidelines between the different nations. Your GP will use these guidelines as well as their experience and judgement.

In England, Wales and Northern Ireland

Your GP should offer you an appointment to see a cancer specialist urgently if you are:

• 50 or over and have a change to a nipple, such as discharge or a nipple appearing to be pulled inwards
• 30 or over and have a lump in your breast, with or without pain, that isn't caused by anything else

You may also be offered an appointment to see a specialist if you have changes to the skin of your breast, such as puckering or dimpling.

If you are under 30 and have a lump in your breast that isn't caused by anything else, your GP might offer you an appointment to see a specialist, but this may not be an urgent referral. Your GP may get advice from a specialist about whether to refer you.

In Scotland

Your doctor should offer you an urgent referral to a specialist if you:

• are over 30 and have a new breast lump
• have a swollen lymph node in your armpit that doesn’t go away after 2 or 3 weeks
• are over 35 and have lumpiness in your breast that doesn't go away after 2 or 3 weeks
• have a cyst in your breast that keeps coming back
• have nipple changes such as pulling inward, a bloodstained discharge, or an exzema-type rash (that doesn't respond to steroid treatment after at least 2 weeks)
• have skin changes, such as tightening, redness and soreness, or looking like orange peel
• inflammation of the breast that doesn't respond to antibiotics

Your GP might offer you an appointment to see a specialist as a routine appointment (rather than an urgent appointment) if you have any of the following:

• have a lump in your breast that isn't caused by anything else and you are under 30
• have lumpiness in your breast that doesn't go away after 2 or 3 weeks and you are under 35
• a persistent discharge from your nipple that is enough to stain your outer clothes
• have breast pain lasting for over 3 months and you are post menopausal
• have severe breast pain that is affecting your daily life or sleep at night

Symptoms that are unlikely to be cancer

There are certain sets of symptoms that are very unlikely to be cancer, such as:

• 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

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.

The risk of getting breast cancer gets higher as you get older. Just over 80 out of every 100 breast cancers (81%) are diagnosed in women aged 50 and over.

If you are worried

If you are worried that your GP isn't taking your symptoms 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.

UK referral guidelines

The National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) produce guidelines for GPs.