Scottish referral guidelines for suspected cancer: quick reference guide

Breast Cancer

Lumps

• 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.

Pain

• 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.