Feature Article

Investigating breast symptoms: meeting the challenge

Helen Zorbas, Elmer Villanueva, Caroline Nehill



The National Breast Cancer Centre has updated its evidence based resource, ‘The investigation of a new breast symptom: a guide for general practitioners’. This article presents the major findings and recommendations for clinical practice.

Key Points

  • Based on the best available evidence, the triple test – thorough history and clinical examination, diagnostic imaging, and nonexcisional biopsy – provides the most effective means of diagnosing breast cancer in women with breast symptoms.
  • The assessment of breast symptoms using the triple test requires a multidisciplinary approach, and is preferably managed by a single clinician who takes responsibility for co-ordinating the entire investigative pathway.
  • A positive result on any component of the triple test (indeterminate/equivocal/atypical, suspicious or malignant) means that the woman should be referred for specialist surgical assessment and/or requires further investigation, irrespective of any other normal test results. This implies that not all three components of the triple test need to be performed to reach the conclusion that appropriate referral is needed.
  • A negative result (normal, benign or no significant abnormality detected) on all three components of the triple test provides good reassurance that the symptom is not due to breast cancer.
  • All test results must be correlated with symptoms. If results are inconsistent or if they are benign but do not account for symptoms then further investigation is warranted.