Breast Cancer

Emergency department referrals

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Uncontrolled or disabling pain or severe uncontrolled dyspnoea
New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
Suspected spinal cord compression or cauda equina syndrome
Symptomatic malignant hypercalcaemia
Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
Febrile neutropenia

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Patients with early stage or locally advanced Breast cancer should be referred to the General Surgery or Breast team for evaluation and further investigation / staging. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

Patients suspected of a new diagnosis of breast cancer presenting with a suspected breast lump/s has to be referred through local surgical pathway for further investigation and biopsy.

Inflammatory breast cancer and patients requiring neoadjuvant chemotherapy (biopsy confirmed) For optimum care, patient should be seen within 2 weeks.
Breast cancer for adjuvant chemotherapy/endocrine therapy.
Metastatic breast cancer (biopsy confirmed)

Category 2

Appointment within 90 days is desirable

Patients on adjuvant hormone treatment for breast cancer with intolerance to current therapy for reconsideration of therapy
Patient on adjuvant hormone treatment for breast cancer for consideration of bisphosphonate therapy outside standard PBS criteria
Previously treated breast cancer patient from another centre requiring routine follow-up
Transfer of care from another health service

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Refer to local HealthPathways or local guidelines
Refer suspected breast lumps through local surgical pathway for further investigation and biopsy
Women with inflammatory breast cancer/many of Her2 positive & triple negative breast cancers receive chemotherapy as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the breast surgical service, not medical oncology.
Histology (biopsy or surgical specimen) should include ER/PR/ HER2 neu status
Serum tumour bio-markers such as CEA, CA15-3 or others should not be used as diagnostic tests
For women who have not completed their family, fertility preservation needs to be discussed
For patients with incurable (metastatic or recurrent) cancer consider the following:
- documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the woman’s prognosis and their understanding of their prognosis
- whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
- specific patient goals and values that may impact on treatment choices
- whether the patient has been referred to a palliative or supportive care service

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Previous cancer treatment details including location; dates; treating doctor; details of prior treatment regimes and imaging / pathology results.
FBC, ELFTs results
Histology /cytology results – current +/- previous
Mammograms results +/- breast US +/- axilla

Additional referral information (useful for processing the referral)

Family history
Other available imaging

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use