GynaecomastiaBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4833 (Published 22 September 2016) Cite this as: BMJ 2016;354:i4833
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Thank you for your very interesting clinical update on the topic of Gynaecomastia. We agree with the proposed investigation and management suggested by you and this is supported by a review of the patients referred to our breast clinic over a 5 year period. We found that in our cohort of 97 patients there was poor documentation with reference to history of testicular problems, family history and recreational drug use.
Blood tests were requested in 35% of patients with almost all results falling within normal limits. Imaging in the form of ultrasound and mammogram were performed in 59% and 30% respectively. The majority of patients (79%) were managed conservatively and were found to have gynaecomastia only. No male breast cancers were detected. Unnecessary investigations in our group of patients added a burden of £3000 in an already financially constrained NHS.
We conclude that blood tests are not indicated for the majority of patients with gynaecomastia. We follow the best practice guidelines and offer imaging in the form of mammography for patient over 40 years, unless otherwise indicated. We also suggest that a specific proforma should be followed to aid assessment of breast lumps in male patients.
Competing interests: No competing interests