Breast 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


REFERRAL GUIDELINES FOR SUSPECTED BREAST CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of breast cancer as detailed in the NICE guidance
  • Only refer when patient is available to attend an appointment within the next 14 days.


In general:

  • Convey optimism about the effectiveness of breast cancer treatments, and survival of breast cancer patients.
  • Discuss the information and support needs of your patient and respond sensitively.
  • Encourage all patients, including women over 50 years old, to be breast aware.

In patients presenting with symptoms and/or signs suggestive of breast cancer, investigation prior to referral is not recommended.

Please refer to NICE referral guidelines for suspected cancer


Referral Criteria

Suspected Cancer Referral:

  • Refer urgently patients:
    • of any age with a discrete, hard lump with fixation, with or without skin tethering
    • who are female, aged 30 years and older with a discrete lump with or without pain that persists after their next period, or presents after menopause
    • who are female, aged younger than 30 years:
      • with a lump that enlarges
      • with a lump that is fixed and hard
      • in whom there are other reasons for concern such as family history
    • of any age, with previous breast cancer, who present with a further lump or suspicious symptoms
    • with unilateral eczematous skin or nipple change that does not respond to topical treatment
    • with nipple distortion of recent onset
    • with spontaneous unilateral bloody nipple discharge
    • who are male, aged 50 years and older with a firm unilateral, firm subareolar mass with or without nipple distortion or associated skin changes.

All other referrals: (Seen within 2 weeks of referral) ·

  • women aged younger than 30 years with a lump
  • patients with breast pain and no palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms. (Use of mammography in these patients is not recommended).

Referral instructions

Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA3 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to:
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