Breast cancer

Triple assessment is required to exclude or diagnose cancer, this involves:

1. Clinical assessment (history and examination)
2. Imaging (ultrasound or mammography)
3. Histology (fine needle aspiration or core biopsy)

Clinical features of breast cancer

• Lumps that are hard, irregular, painless or fixed in place
• Lumps may be tethered to the skin or the chest wall
• Nipple retraction
• Skin dimpling or oedema (peau d’orange)

The NICE guidelines (updated January 2021) recommend a two week wait referral for suspected breast cancer for:

• An unexplained breast lump in patients aged 30 or above
• Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

The NICE guidelines recommend also considering a two week wait referral for:

• An unexplained lump in the axilla in patients aged 30 or above
• Skin changes suggestive of breast cancer

The NICE guidelines suggest considering non-urgent referral for unexplained breast lumps in patients under 30 years.