Breast – benign and malignant - Metro North Health (dev)

Emergency referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Diagnosed breast cancer:
- early (confined to breast)
- locally advanced (spread to involve areas near the breast)
- secondary spread (involving areas outside the breast e.g. lymph node
Inflammatory breast cancer (rare, involves lymphatic spread causing inflammation in the breast)
Recurrent breast malignancy
Suspicious lesion on breast screening mammography or FNAC
Suspicious breast mass on clinical examination
Ductal carcinoma-in-situ (non-invasive confined to the ducts)
Lobular carcinoma-in-situ (non-invasive confined to lobules)

Breast lump

New diagnosis or clinically suspicious of primary breast malignancy (biopsy or mammogram proven)
New discrete lump
Young women with tender, lumpy breasts
Asymmetrical nodules that persist at review after menstruation
Older women with symmetrical nodules provided that they have no localised abnormality
Any lump that increases in size
Ductal papilloma
Cyst persistently refilling or recurrent cyst

Breast pain

Unilateral persistent mastalgia
Severe intractable pain
Localised areas of painful nodularity/ focal lesions

Nipple discharge, nipple retraction, change in skin contour

Bilateral discharge sufficient to stain clothes
Blood stained discharge
Persistent single duct
Nipple retraction/distortion
Nipple eczema
Paget’s disease of the nipple

Category 2

Appointment within 90 days is desirable

Benign breast disease for consultation
Low-risk breast lumps/cysts
Patient referred for screening for breast malignancy or prophylactic mastectomy
Gynaecomastia
Nipple discharge (non-blood stained)
Ductal papilloma
Fibroadenoma (diagnostic excision biopsy if diagnostic uncertainly)

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

USS both breast if:
- <35 years old with:
  - breast lump or thickening or axillary mass
  - if a localised abnormality or suspicious lesion proceed to FNAB or core biopsy
Bilateral mammogram and USS if:
- >35 years old with significant breast symptoms or significant clinical findings
Consider referral to Geneticist for familial genetic screening if appropriate
Discuss lifestyle modifications for cancer reduction risk (increased activity, dietary, weight, smoking, alcohol)
Aboriginal and/or Torres Strait Islander people support services for breast cancer are available
Best practice information on breast cancer – Cancer Australia, Clinical Best Practice, Breast Cancer
GP guides and resources for breast cancer – Cancer Australia, Clinical Best Practice, Breast Cancer, GP guides and resources
Cancer risk reduction – Cancer Australia, Healthy living, Lifestyle & risk reduction
Familial risk assessment tool – Cancer Australia, Clinical Best Practice, Familial risk assessment (FRA BOC)
Information of genetic testing – Cancer Australia, Clinical Best Practice, Genetic testing
The Breastscreen program -50-74 years – is funded to investigate asymptomatic patients only to the point of clear diagnosis (accepts woman in their 40s or 75 years and over) – BreastScreen Queensland
Guide for investigation of a breast lump – Triage process for presentation with no family or past history. Adaption from general surgery review process CDHB2001. AlfredHealth, Referral Guidelines: Breast, endocrine & general surgery

Referral requirements

A referral may be rejected without the following information.

Essential referral information

General referral information
Document details/duration symptoms
Document family history of breast cancer
Description of clinical findings
Medical management to date
Current USS/mammography results
Current FNAC or core biopsy results
Any previous relevant investigation results

Additional referral information (useful for processing the referral)

Staging investigations e.g. Bone scan, CT scan (if available)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient’s Demographic Details (essential)

Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Other Information (where relevant)

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Breast – benign and malignant