Many breast lumps will be benign, but the possibility of breast cancer necessitates taking a careful history, performing a thorough examination, organising appropriate investigations and, if necessary, prompt referral of the patient to a breast specialist.
- History should include an assessment of the patient’s risk factors for breast cancer, which may raise the index of suspicion for the GP, radiologist and/or breast specialist.
- Breast examinations can be embarrassing and awkward, so the patient should be given clear instructions and some privacy.
- As much information as possible should be provided on imaging request forms.
- If a distinct lump is present, ultrasound is the investigation of choice – in addition to mammography for older women or as an alternative to mammography for younger women.
- Core biopsy provides more information than fine-needle aspiration cytology for solid lesions but may not be suitable for all lesions or all patients.
- When in doubt, the patient should be referred to a breast specialist.