ABC of Breast Diseases : Symptoms Assessment and Guidelines for ReferralBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6956.722 (Published 17 September 1994) Cite this as: BMJ 1994;309:722
- J M Dixon,
- R E Mansel
“Bathsheba bathing” by Rembrandt. The model was Rembrandt's mistress, and much discussion has surrounded the shadowing in her left breast and whether this represents an underlying malignancy.
A breast lump, which may be painful, and breast pain constitute over 80% of the breast problems that require hospital referral, and breast problems constitute up to a quarter of the general surgical workload.
Guidelines for referral to hospital
Conditions that require hospital referral
All patients with a discrete mass (aspiration of masses by general practitioners is not encouraged because bruising can follow aspiration of a solid mass, making subsequent assessment difficult)
Nipple discharge in patients aged over 50, and bloodstained, persistent, or troublesome nipple discharge in younger patients
Mastalgia that interferes with patient's lifestyle or sleep and which has failed to respond to reassurance, simple measures such as wearing a well supporting bra, and common drugs
Nipple retraction or distortion, change in skin contour, or nipple eczema
Request for assessment by a patient with a strong family history of breast cancer
Asymmetrical nodularity that persists at review after menstruation
Patients who can be managed at least initially by their general practitioner
Young patients with tender, lumpy breasts and older patients with symmetrical nodularity, provided that they have no localised abnormality
Patients with minor and moderate degrees of breast pain who do not have a discrete palpable lesion
Patients aged under 50 who have nipple discharge that is from more than one duct or is intermittent and is neither bloodstained nor troublesome
When a patients presents with a breast problem the basic question for the general practitioner is, “Is there a chance that cancer is present, and, if not, can I manage these symptoms myself?”
For patients presenting with a breast lump, the general practitioner should determine whether the lump is discrete or is an area of lumpiness or nodularity. A discrete lump stands out …
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