Scottish referral guidelines for suspected cancer: quick reference guide

Scottish Referral Guidelines for Suspected Cancer is a quick reference guide for cancer referrals.

Breast Cancer


  • Any new discrete lump.
  • New lump in pre-existing nodularity.
  • New asymmetrical nodularity that persists at review after menstruation.
  • Non-lactational abscess or mastitis which does not settle after one course of antibiotics.
  • Abscess in patient >40 even if settles with antibiotics.
  • Cyst persistently refilling or recurrent.
  • Unilateral axillary lymph node.


  • Unilateral persistent pain in post-menopausal women.
  • If associated with a lump.
  • Intractable pain that interferes with lifestyle.

Nipple Symptoms

  • <50 with discharge which is bloodstained (dipstick) or bilateral and sufficient to stain clothes or persistent single duct discharge.
  • All women >50 with discharge.
  • New nipple retraction.
  • Nipple eczema if none elsewhere or unresponsive to topical steroids.

Skin Changes

  • Skin tethering.
  • Fixation.
  • Ulceration.
  • Abscess or inflammation not settled after one course
    of antibiotics.
  • Abscess or inflammation in patient >40 yrs even if settles
    with antibiotics.

For risk associated with a positive family history, see section on Assessing Genetic Risk.

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