Q.I am a GP and would like to refer a patient.
Your local hospital might offer a breast service and it is best to make a direct referral to the breast clinic. Your local A&E is unlikely to be resourced to manage breast related issues but you could check and make appropriate referral.
Here is a link to NICE guidelines for suspected cancer
https://www.nice.org.uk/guidance/ng12/chapter/1-Recommendations-organised-by-site-of-cancer#breast-cancer
and breast referral practice guidelines
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiEk4z9g8vaAhVCe8AKHZYRD58QFggtMAE&url=http%3A%2F%2Fwww.ncin.org.uk%2Fview%3Frid%3D303&usg=AOvVaw2Qit5nF8mgRr5C_KLoHQVt
Q.I am a patient with breast symptoms (pain or discharge or feeling a lump or any other issues) and worried about cancer
Please contact your GP in the first instance who would assess you and refer to a specialist.
You may find this information helpful
Breast cancer - recognition and referral | Health topics A to Z | CKS | NICE
Q.I am a patient without breast related symptoms but received an invitation to attend breast screening.
Please see the information available to individuals considering attending the programme
https://www.gov.uk/government/collections/breast-screening-information-leaflets
Q.I have seen my GP and have been referred to breast care unit, what happens now?
You would receive an appointment letter to visit specialists in your local hospital. You would be seen by consultant radiologist/ surgeon or radiographer in the clinic and then referred to X-ray (radiology department) for a mammogram (usually 40 years or above) and or an ultrasound scan. A consultant breast radiologist (Doctor trained in breast ultrasound and reporting mammograms)reports your mammograms and also performs an ultrasound scan. You may require a needle test(biopsy or aspiration), which is decided upon the result of your mammogram or ultrasound scan. In some hospitals other specialists(radiographer or a surgeon) might perform an ultrasound and mammogram, if they are trained to do so.
Q.How long does a hospital appointment take?
Please expect 3 hour from the appointment time on your letter. It would be sooner if examination results are normal or might take longer if you require a needle test. If you undergo a biopsy, you would be provided with a follow up appointment or contact details of a specialist nurses to discuss the results.
Q.What is a one stop and two stop clinic?
Patients attending one stop clinic undergo clinical examination, X-ray appointment and any needle test on the same day. Patients attending a two stop clinic undergo clinical examination on one day and are given another date for X-ray appointment. Patients have a choice of a few dates for X-ray appointment in a two stop clinic to suit you. Some patients visit the breast clinic in one stop but may wish to bring a family or friend along for biopsy and a two stop clinic might suit their need better.
Q.My mammograms show calcium (microcalcification), what does that mean?
Calcium(micro calcification) in mammograms could be due to normal or benign(not cancer) process or it could be a sign of cells changing with potential to become cancer in future.Best way to decide is a biopsy with X-rays which is also called stereotactic biopsy or an ultrasound(if calcium is seen on ultrasound). A comparison with your old mammograms could be helpful in deciding if you need a biopsy or not.Here is a demonstration of micro calcification on mammograms
https://www.youtube.com/watch?v=zjYywmfaPI4
Q.I have breast implants, can I have mammograms?
Please follow the link for NHSbreast screening programme advice
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/441256/breast-implants-breast-screening.pdf
Q.I am pregnant, can I have mammograms
Please see the latest guidelines
http://www.breastcancer.org/tips/fert_preg_adopt/bc_pregnancy/screening
Q.I have an appointment for biopsy, what should I know?
An ultrasound or X-ray biopsy should be performed by someone with formal training to carry out such procedure (Breast Radiologist or radiographer) with formal training in carrying out such procedures.You need to inform if you had any allergic reaction to a local anaesthetic or sticking plasters or if you take any blood thinning medicines like aspirin, warfarin, rivaroxaban etc. If your hospital does not offer specialist service then you might be referred to your regional centre for a biopsy.
After the biopsy, you should have next appointment or contact details of breast care nurse to know the results. If you do not get your results within 2 weeks, please call the breast care nurses to enquire the results.
Q.Is it painful?
You would receive a local anaesthetic to numb the area but you would feel little pushing and pulling of the needle. If you feel pain, let us know and we can give you more anaesthetic or more time for the local anaesthetic to be effective. Unfortunately, sometimes the location of abnormal area (very close to the muscle and bone) makes it difficult to be completely pain free.
Q.I have an appointment for an ultrasound breast biopsy, what should I expect?
A formally trained specialist (usually a consultant breast radiologist)would perform an ultrasound scan and decide if you require a biopsy or not.
If you require a biopsy the procedure information leaflet shall be provided with your appointment letter and you may find this video helpful
https://www.youtube.com/watch?v=-PYKLe4R3tU
Q.What can I do or not do after a biopsy
You would be advised on these and provided with one from your hospital with their contact details. Here is one generic post biopsy care leaflet
https://www.hey.nhs.uk/patient-leaflet/breast-biopsy-local-anaesthetic-aftercare-advice/
Q.I have an appointment for X-ray guided biopsy, what should I expect?
If you require a biopsy the procedure information leaflet shall be provided with your appointment letter and you may find this video helpful
https://www.youtube.com/watch?v=YPUqKTqTV5s
Q.I have an appointment for wire localisation of my breast lump. What is this procedure?
Wire localisation is performed by a breast radiologist usually on or a day before the surgery to mark the area of suspected breast cancer using ultrasound or mammogram machine.If you require a localisation procedure the information leaflet shall be provided with your appointment letter and you may find this video helpful.
https://www.youtube.com/watch?v=68RxrTtNnQs
Q. I had the biopsy, can I shower swim?
You would be advised on these and provided with one from your hospital with their contact details. Here is one generic post biopsy care leaflet.
https://www.hey.nhs.uk/patient-leaflet/breast-biopsy-local-anaesthetic-aftercare-advice/
Q. I had the biopsy, when will I know the results?
After biopsy the samples are sent to the pathology department and a consultant pathologist issues the report. It takes at least a week for the results to be available and these results are then discussed by all the specialists involved in your care(Radiologist/Pathologist/Oncologist/Surgeon/Breast care nurses) in a meeting to decide the available treatment options, before discussing the results with you. Breast surgeon would discuss these results and different treatment options with you to help you make an informed decision.
If your biopsy result is normal or benign (no cancer), you might receive a letter confirming the same and there is no need for another appointment. Your hospital might ask you of your preferred way to get the result via phone or letter or a clinic appointment.
Q. My biopsy result is benign, what do I need to do?
That is good news and you are reassured that there is no cancer in the breast lump or calcium on mammograms. Even when benign, some patients choose to get the lump removed, please discuss the options with your surgeon/GP. The benign lump could be a cyst which is normally removed by ultrasound guided needle aspiration, here is a link on what to expect
https://www.youtube.com/watch?v=yUY2aGpogGc
or a fibroadenoma which could be removed by surgery or ultrasound guidance, here is a link on what to expect for ultrasound guided procedure
https://www.youtube.com/watch?v=6v3Kt_1q8yY
Q.My biopsy result is uncertain or indeterminate, what does that mean?
Sometimes the biopsy is inconclusive for various reasons i.e. not enough biopsy sample to test or mismatch between radiology/pathology opinion or unexpected cancer or unexpected normal. In any of these scenarios the usual way forward is to repeat the biopsy to make sure the results match.
When it is not possible to repeat the biopsy, sometimes surgical removal is advised to get a larger sample for further tests to be performed.Such cases are very few.
Q.My biopsy result shows cancer, what do I need to do?
You would have had appointment to discuss the results and treatment options with the surgeons or oncologist. Surgery, chemotherapy before or after surgery and radiotherapy options would be discussed with you. You might have an idea about best option for you or you may wish to discuss the advantages and disadvantages of different options before making up your mind. You may find this information helpful
http://www.macmillan.org.uk/information-and-support/breast-cancer/treating
Some patients are managed with just medication (no surgery) and regular follow up especially if they have other medical conditions which would make surgery difficult.
Q. What are my treatment options?
There is a host of treatment options. Most women would have consultation with the surgeons and would be offered either lumpectomy which is removal of the cancer lump or mastectomy which is removal of the whole breast. Lumpectomy is usually preferred option for a small size lump and mastectomy is the preferred option when disease involves large part of the breast. Here is what you need to know before you make up your mind.
http://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/lumpectomy-or-mastectomy
Further treatment options are available at
https://www.nhs.uk/conditions/breast-cancer/treatment/
Q. I do not want surgery, is it an option?
Sometimes it is not possible to offer surgery especially when someone is not fit for surgery or You may have your own reasons for not choosing a surgery. Please discuss non surgical management options, you could always change your mind and opt for surgery at a later stage. The risks and benefits of a non surgical option would be explained to you during your consultation. After biopsy some patients may choose for medical/ tablets to manage or control the disease as surgery does not offer any additional benefit in terms of survival.
Q. How long will it take for surgery? Do I need hospital admission?
All UK hospitals work towards a 62 day national target from referral to the surgery. Some hospitals offer day surgery option and you could return home the same day after a short period of observation, please discuss with your surgeon, if you prefer this option. You may find this information helpful
http://www.macmillan.org.uk/information-and-support/breast-cancer/treating/surgery/surgery-explained/what-happens-before-surgery.html
Q. I have a wire localisation and dye test procedure before my surgery,what is this?
A wire localisation is performed by a radiologist using ultrasound or mammogram before your surgery. When the cancer very small or difficult to find by clinical examination, the radiologist can mark the site of cancer by placing a thin metal wire through it. This helps the surgeon to feel the wire and remove the cancer during surgery. If your wire is placed using ultrasound guidance, a mammogram will be performed that the wire is in a good position. If the wire is not in a good position, then a second wire may be placed in the tumour and both the wires are removed during surgery. Here is a demonstration of ultrasound guided wire localisation.
https://www.youtube.com/watch?v=68RxrTtNnQs
Dye test or nuclear medicine test is to find any lymph nodes in your underarm which might contain cancer cells, too small, to be picked up by ultrasound and clinical examination.
Q. Would the cancer spread if my surgery is delayed?
Most hospitals meet the national target, currently of 62 days from the date of referral to your local hospital. There is no convincing evidence to suggest that if surgery is slightly delayed for any reason, it would impact your care or outcome and majority breast cancers do not spread so quickly.
Q. I have holidays booked...
It depends on the time of the holidays and if coincides with the surgery. You might have an option of postponing it or a refund through your insurance. If you are not on a long holiday, it is usually not an issue but discuss your options with the surgeons.
Q. Would it affect my holiday insurance?
The stage of the disease might affect future insurance, please clarify this with your insurer or travel agent. You may wish to choose specialist companies or insurance policies that suit your need.
Q. I had my surgery, what happens next?
You would be supported by the surgeons and breast care nurses. You may find this information helpful
http://www.macmillan.org.uk/information-and-support/breast-cancer/treating/surgery/surgery-explained/what-happens-after-surgery.html
The drains normally come off in 2-3 days. You would have an appointment with Oncologist (medical consultant with training in cancer treatment) to discuss the possible dates and requirement for radiotherapy and chemotherapy.
Q.What happens after my surgery and discharge from the hospital?
You would be supported by the surgeons and the breast care nurses during recovery period. You may find this information helpful
http://www.macmillan.org.uk/information-and-support/breast-cancer/treating/surgery/surgery-explained/what-happens-after-surgery.html#7214.
Q.I need more help with other issues
You may be provided with information on local support in your area and you may find this helpful
http://www.macmillan.org.uk/information-and-support
Q.How long is the follow up care/ appointment?
It is normal for a patient to be followed up yearly for the first five years. Follow up also depends on your age at the first diagnosis of cancer and it might be continued till you reach a screening age. If you have any concerns then you could always book an appointment to see a surgeon or a radiologist. After 5 years, you would be expected to follow self referral path via breast care nurse or via your GP.
Q.I have completed my 5 year follow up, what happens now?
After 5 years disease free period, you would be expected to follow self referral path via breast care nurse or via your GP.