ABC of Breast Diseases : Symptoms Assessment and Guidelines for Referral

Bathsheba bathing" by Rembrandt.The model was Rembrandt's mistress, and much discussion has surrounded the shadowing in her left breast and whether this represents an underlying malignancy.A breast lump, which may be painful, and breast pain constitute over 80% of the breast problems that require hospital referral, and breast problems constitute up to a quarter of the general surgical workload. Guidelines for referral to hospitalConditions that require hospital referral * All patients with a discrete mass (aspiration of masses by general practitioners is not encouraged because bruising can follow aspiration of a solid mass, making subsequent assessment difficult) * Nipple discharge in patients aged over 50, and bloodstained, persistent, or troublesome nipple discharge in younger patients * Mastalgia that interferes with patient's lifestyle or sleep and which has failed to respond to reassurance, simple measures such as wearing a well supporting bra, and common drugs * Nipple retraction or distortion, change in skin contour, or nipple eczema * Request for assessment by a patient with a strong family history of breast cancer * Asymmetrical nodularity that persists at review after menstruation Patients who can be managed, at least initially, by their general practitioner * Young patients with tender, lumpy breasts and older patients with symmetrical nodularity, provided that they have no localised abnormality * Patients with minor and moderate degrees of breast pain who do not have a discrete palpable lesion * Patients aged under 50 who have nipple discharge that is from more than one duct or is intermittent and is neither bloodstained nor troublesome