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Which patients you should consider referring to the suspected cancer pathway for breast cancer
In 2014, in the UK there were 55,222 new cases of invasive breast cancer and 11,433 deaths reported; 78% of new diagnoses are expected to live for 10 years and longer, following diagnosis, and most cases being diagnosed are in the 50-69 age group.
Concerns around inheriting breast cancer are very common for women who have a family history of breast cancer. According to NICE there are three different risk groups:
A woman’s lifetime risk of developing breast and ovarian cancer is greatly increased if she inherits a harmful mutation in the BRCA gene – BRCA1 and BRCA2 are human genes that produce tumour suppressor proteins.
For those who have inherited the BRCA1 gene, there is a 50-85% risk of developing breast cancer by age 70, and 40-60% risk of developing ovarian cancer by age 85.
For those who have inherited the BRCA2 gene, there is a 50-85% risk of developing breast cancer by age 70.
Screening, prophylactic surgery and chemoprevention are preventative mechanisms commonly used to lower the risk or to prevent cancer from developing.
According to NICE guidelines (2015), a suspected cancer pathway referral for breast cancer should be considered for people who are:
Similarly, a suspected cancer pathway referral for breast cancer should be considered in people:
A patient may present the following after examination:
Similarly, a patient may present with breast pain. According to recent figures, one in five women are seen in breast clinics for reporting breast pain. Although it must be communicated that in the absence of any other symptoms or signs, breast pain is not a sign of cancer, patients should be encouraged to see a GP about breast pain, if:
If examination is normal, no further investigation is required in women under 40. Those who are over 40 should be offered an opportunistic mammogram.
For symptomatic patients, The Royal Marsden offer a triple assessment for cancer out of the Rapid Diagnostic and Assessment Centre (RDAC), including,
The main stay of standard treatment for breast cancer is still surgery, which has become less aggressive over the last 30 years. However, survival rates have been improving mostly due to adjuvant systematic treatment. Neoadjuvant treatment can be used to down stage disease in the breast and axilla. Primary endocrine treatment or radiotherapy can also be given for patients considered not fit for surgery.