Reviewed on : 6 Aug 2026

Reviewed by : Gateway Editor

Expires : 6 Aug 2028

BREAST URGENT SUSPECTED CANCER REFERRAL USC

Refer as below:

Suspicion of Breast Cancer

• Discrete, hard lump + fixation + skin tethering
• 30 years and older with a discrete lump that persists post-period / menopause
• Spontaneous unilateral bloody or blood-stained nipple discharge or which stains clothes
• Nipple retraction or distortion of recent onset (<3 months onset)
• Skin distortion/tethering/ulceration/Peau d’orange
• Unexplained lump in axilla

Symptomatic but NOT suspicious

• Patient <30 years with a lump
• Patient with asymmetrical nodularity or thickening persisting for more than 4-6 weeks or still present after menstruation
• Unilateral, spontaneous, nipple discharge that is persistent or troublesome
• Infection or inflammation that fails to respond to antibiotics
• Unilateral eczematous skin areola or nipple (Please do not refer until tried topical treatment such as 0.1% mometasone for 2 weeks)
• Patients with breast pain alone (no palpable abnormality)
• Breast pain alone is not a sign of breast cancer and can be managed initially in primary care.  Use 2-3 months regular NSAID or paracetamol as a minimum – (see Breast Pain Pathway) – https://www.coventryrugbygpgateway.nhs.uk/pages/breast-symptoms/

Suspicion of Recurrence of Known Breast Cancer

First 5 years after surgery patient can contact Breast Care Nurse.  After 5 years if suspicion/confirmed recurrence that patient may be referred to Breast MDT

NB: Breast asymmetry without discrete lump must not be referred

Consider printing for your patient a Cancer Research UK Urgent Referral Leaflet – follow link

All referrals should be made through the NHS eRS

Please make all referrals (urgent and non-urgent) within 1 day in accordance with the NICE Cancer Recognition & Referral Guidelines (NG12) – Breast

If in doubt about the referral please contact one of the breast specialists by phone or by e mail Advice & Guidance for further advice, although your non urgent referral letters will be vetted by a specialist and the appointment accelerated if necessary.

Breast Pain Pathway – see link right

We are pleased to announce the launch of a new Breast Pain Pathway (September 2025) designed to support GPs in the effective management of patients presenting with breast pain, a common but often benign symptom

Why This Matters

• Breast pain alone is not typically associated with breast cancer
• Up to 20% of breast referrals are for pain only, often resulting in unnecessary imaging and anxiety
• This pathway aims to reduce inappropriate referrals, free up diagnostic capacity, and improve patient reassurance and satisfaction

Referral Criteria:

• • Refer non-urgently only if symptoms persist after following the simple mastalgia pathway for 3 months
  • Normal examination by referrer
  • Breast pain only
  • Use e-Referral Service (select “Urgent Suspected Cancer – Breast Pain”) however the pathway also remains accessible through the (Urgent Suspected Cancer – Breast Symptomatic) by selecting breast pain on the 2WW wait form