Clinic/Appointment Information: The Northern Hospital (TNH) 185 Cooper St, Epping Tel: Fax:

Transcription

1 Northern Health Breast Clinic Pre-referral Management Guidelines Breast Consultants: Clinic/Appointment : Professor H. Ewing Mr D. Butterfield Ms W. Stelmach Dr.F.Barnett Dr.S. White Dr.J. Stewart Dr.M. Ng The Northern Hospital (TNH) 185 Cooper St, Epping Tel: Fax: Craigieburn Health Service (CHS) 350 Craigieburn Rd West, Craigieburn Tel: Fax: VSRF Referral Form Referral must contain detailed information on: - History - Medications - Investigations (patient to bring results/films as appropriate) Conditions seen include: Breast Lump/Lumpiness Breast Pain Nipple Discharge Nipple Inversion or retraction Change in breast shape/appearance and/or contour Family History Request for assessment by a woman with a strong family history of breast cancer Conditions not seen include: The Breast Clinic holds a weekly multidisciplinary cancer meeting to discuss and plan the treatment of patients with breast cancers Further information about this meeting can be found at the NEMICS website Click here Triage Categories/ Appointment Wait Time Emergency/After Hours: : Call the Emergency Department 0 3 weeks GP Hotline on / to access the Senior ED Consultant 3 6 weeks >6 weeks Page 1 of 5

2 Breast Lump/Lumpiness - Duration - Cyclical variation - Pain - Skin changes - Nipple discharge - Family history - (Use NBOCC link: - Location - Discrete vs ill defined - Skin/contour change - Nodes - Nipple discharge - Unilateral vs bilateral - Bloody discharge Suggested GP Management initially: - Young women with tender, lumpy breasts and older women with symmetrical nodularity - review at day 7-10 in cycle to assess hormonal contribution - New diagnosis of primary breast malignancy (biopsy or mammogram proven) - Imaging mammography and/or ultrasound (not Breast Screen) DO NOT BIOPSY PRIOR TO CLINICAL REVIEW BY A SPECIALIST Page 2 of 5

3 Breast Pain - Duration - Cyclical component - Discrete lumps Women with minor/moderate degrees of breast pain who do not have a discrete palpable lesion: Abscess If pain is associated with a lump - Standard examination Unilateral persistent mastalgia: - Bilateral mammography and breast ultrasound if over 35 years Localised areas of painful nodularity: - Bilateral mammography and breast ultrasound if over 35 years - Provide mastalgia advice Recommend : - well fitted bra - elimination of caffeine - evening primrose oil, Vit B1/B6 GP education resources - National Breast and Ovarian Cancer Centre (NBOCC) - Intractable pain not responding to reassurance or simple measures - Unilateral, persistent pain in postmenopausal women Nipple Discharge History and - Unilateral - Spontaneous - Clear or blood stained - Associated nipple surface changes - Single duct Benign features - Bilateral with expression - Creamy/green/brown in colour - Multiple duct Investigations - Mammography if over 35 years - -Ultrasound for all patients Benign features with inflammation Benign features requiring reassurance Page 3 of 5

4 Nipple Inversion or Retraction - Standard - Benign features - Long standing - Bilateral - Nipple stalk alone - History of inflammation - Short duration - Unilateral - Appearance like a button on a Chesterfield couch - Associated nipple scaling or ulceration Benign features - Reassurance - Nipple Hygiene - Cease smoking - Refer Benign features requiring reassurance Assessment regarding cosmetic correction/eversion surgery Change in Breast Shape/Appearance and/or contour - Mammography - Ultrasound History Standard Examination - Make sure to examine patient upright and in well-lit conditions - Elevate arms above head to assess lower breast - Presence of underlying mass Refer all New dimpling with mass All others Investigations - Mammography - Ultrasound Page 4 of 5

5 Family History - Get patient thinking about all cancer diagnoses within the family - Include details of age at diagnosis - unilateral vs bilateral Suggested GP Management - Use NBOCC Risk Assessment Tool Familial Risk Assessment - Breast and Ovarian Cancer (FRA-BOC) - NBOCC Patients determined to have high or moderate risk on NBOCC Risk Assessment Tool - Standard examination - Mammogram and ultrasound if less than 10 years younger than youngest member diagnosed in kindred - If high refer to clinic - If moderate consider surveillance or refer Page 5 of 5