Refer on the suspected cancer pathway for an unexplained breast lump at 30 or over, or a hard fixed lump, skin change, nipple retraction, or unilateral bloodstained discharge at any age.
Benign clues
- Cyclical pain and a smooth mobile lump in a younger woman
- Fibroadenoma common under 30
- Simple cysts
- Reassure only after appropriate assessment, not on history alone
Triple assessment
- 1. Clinical examination
- 2. Imaging: USS under 40, mammography (plus USS) at 40 and over
- 3. Core biopsy of any suspicious lesion (cytology for cysts)
Likely benign
- Cyclical, bilateral nodularity
- Fibroadenoma features in the young
- Triple assessment if any doubt
Consider referral
- Under 30 with an unexplained lump
- Unilateral bloody discharge
- Use clinical judgement
Urgent 2-week-wait
- 30 or over with unexplained lump
- Nipple change or skin tethering
- Suspicious axillary node
GP and clinic pathway
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1. History
Duration and change, family history of breast or ovarian cancer, hormonal factors (HRT, pregnancy, lactation), skin and nipple changes.
Duration and change, family history of breast or ovarian cancer, hormonal factors (HRT, pregnancy, lactation), skin and nipple changes.
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2. Examine
Inspect and palpate all quadrants and the axilla, both arms raised and by the sides. Note fixation and lymph nodes.
Inspect and palpate all quadrants and the axilla, both arms raised and by the sides. Note fixation and lymph nodes.
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3. Refer
Two-week-wait for the criteria above; consider it for unexplained skin or nipple change. Otherwise a routine breast clinic referral.
Two-week-wait for the criteria above; consider it for unexplained skin or nipple change. Otherwise a routine breast clinic referral.
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4. Safety-net
Advise return if the lump grows, the skin dimples, or new discharge or nipple change occurs.
Advise return if the lump grows, the skin dimples, or new discharge or nipple change occurs.
NICE NG12 pointers
- Age 30 and over with an unexplained breast lump: 2WW
- Age 50 and over with nipple discharge, retraction or change: 2WW
- Skin changes suggestive of cancer: consider 2WW
- Lump in the axilla at 30 and over: consider 2WW
Pitfalls
- Reassuring a woman 30 or over without referral
- Over-reliance on a normal mammogram when a lump is clinically suspicious
- Forgetting male breast cancer
- Not examining the axilla
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026