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Referral
Breast pain
For many breast problems, especially in younger patients or patients presenting with mastalgia only, reassurance and a period of watchful waiting may be suitable.
Breast pain is not usually associated with malignancy. It is a common symptom and, if of short duration with no other clinical concern, may be managed initially in a primary care setting. Studies show that breast pain often settles with 3-6 months.
Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms, greater than 3 months need to be referred as non-urgent.
Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.
“In the presence of a normal physical examination, simple breast pain is not associated with an increased risk of cancer. There is an excellent training resource via this link which is endorsed by all breast specialists in Devon and Cornwall. You can also read the joint statement on the management of breast pain issued by the association of breast surgery here.
Signs and Symptoms
- Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms, greater than 3 months, need to be referred as non-urgent
- Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.
“In the presence of a normal physical examination, simple breast pain is not associated with an increased risk of cancer. There is an excellent training resource via this link which is endorsed by all breast specialists in Devon and Cornwall. You can also read the joint statement on the management of breast pain issued by the association of breast surgery here.
Investigations in patients presenting with symptoms and/or signs suggestive of breast cancer prior to referral is not recommended.
- Management in primary care should include:
- Reassurance
- Advice on supportive, fitted bras
- Oral or topical analgesia
- Review of any hormonal medications the patient may be taking
- Breast pain alone is not an indication for imaging
- Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with other symptoms need to be referred as non-urgent
- Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.
“In the presence of a normal physical examination, simple breast pain is not associated with an increased risk of cancer. There is an excellent training resource via this link which is endorsed by all breast specialists in Devon and Cornwall. You can also read the joint statement on the management of breast pain issued by the association of breast surgery here.
Referral criteria
Refer as non-urgent patients with minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms
Referral instructions
Use the e-Referral Service to book the appointment, if no appointment available, click "defer to provider"
e-Referrals service selection:
- Priority: 2WW
- Service: Surgery - Breast
- Clinic type: Other symptomatic Breast
- Service: DRSS-Western-Breast-(Patient will be seen within 2 weeks)-ICB-15
Referral form
Please refer using a standard referral letter
All patients whether on the 2WW pathways or symptomatic breast pathway are normally seen within 2 weeks.
Further guidance
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: January 2020
