Breast – benign and malignant

Emergency department referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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

  • Diagnosed breast cancer:
    • early (confined to breast)
    • locally advanced (spread to involve areas near the breast)
    • secondary spread (involving areas outside the breast e.g. lymph node
  • Inflammatory breast cancer (rare, involves lymphatic spread causing inflammation in the breast)
  • Recurrent breast malignancy
  • Suspicious lesion on breast screening mammography or FNAC
  • Suspicious breast mass on clinical examination
  • Ductal carcinoma-in-situ (non-invasive confined to the ducts)
  • Lobular carcinoma-in-situ (non-invasive confined to lobules)

  • New diagnosis or clinically suspicious of primary breast malignancy (biopsy or mammogram proven)
  • New discrete lump
  • Young women with tender, lumpy breasts
  • Asymmetrical nodules that persist at review after menstruation
  • Older women with symmetrical nodules provided that they have no localised abnormality
  • Any lump that increases in size
  • Ductal papilloma
  • Cyst persistently refilling or recurrent cyst
  • New lump during pregnancy

  • Continuous mastalgia
  • Localised areas of painful nodularity/ focal lesions

  • Discharge sufficient to stain clothes
  • Blood stained discharge
  • Persistent single duct
  • Nipple retraction/distortion
  • Nipple eczema
  • Paget’s disease of the nipple

Category 2

Appointment within 90 days is desirable

  • Benign breast disease for consultation
  • Low-risk breast lumps/cysts
  • Patient referred for screening for breast malignancy
  • Nipple discharge (non-blood stained)
  • Ductal papilloma
  • Fibroadenoma (diagnostic excision biopsy if diagnostic uncertainty)
  • Intermittent mastalgia i.e. Hormonal
  • Gynaecomastia where there is substantial breast enlargement or significant breast tenderness and where breast size is disproportionate to body habitus

Category 3

Appointment within 365 days is desirable

  • Gynaecomastia
  • Prophylactic mastectomy

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

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • USS both breast if:
    • <35 years old with:
      • breast lump or thickening or axillary mass
      • if a localised abnormality or suspicious lesion proceed to FNAB or core biopsy
  • Bilateral mammogram and USS if:
    • >35 years old with significant breast symptoms or significant clinical findings
  • Consider referral to Geneticist for familial genetic screening if appropriate
  • Discuss lifestyle modifications for cancer reduction risk (increased activity, dietary, weight, smoking, alcohol)
  • Aboriginal and/or Torres Strait Islander people support services for breast cancer are available
  • The BreastScreen program – 50-74 years – is funded to investigate asymptomatic patients only to the point of clear diagnosis (accepts woman in their 40s or 75 years and over).

Referral requirements

A referral may be rejected without the following information.

  • Document details/duration symptoms
  • Document family history of breast cancer
  • Description of clinical findings
  • Medical management to date
  • Current USS/mammography results
  • Current FNAC or core biopsy results
  • Any previous relevant investigation results
  • Gynaecomastia require BMI

Additional referral information useful for processing the referral

  • Staging investigations e.g. Bone scan, CT scan

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.

  • 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
  • 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
  • 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
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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