For patients presenting with a breast lump, the general practitioner should determine whether the lump is discrete or if there is nodularity whether this is asymmetrical or is part of generalized nodularity. A discrete lump stands out from the adjoining breast tissue, has definable borders, and is measurable. Localised nodularity is more ill defined, often bilateral, and tends to fluctuate with the menstrual cycle. About 10% of all breast cancers present as asymmetrical nodularity rather than a discrete mass. When the patient is sure there is a localised lump or lumpiness, a single normal clinical examination by a general practitioner is not enough to exclude underlying disease. Reassessment after menstruation or hospital referral should be considered in all such women

Conditions that require hospital referral Lump

  • Any new discrete lump
  • New lump in pre-existing nodularity
  • Asymmetrical nodularity in a postmenopausal woman
  • Asymmetric nodularity in a premenopausal woman that persists at review after menstruation
  • Abscess or breast inflammation that does not settle after one course of antibiotics
  • Cyst persistently refilling or recurrent cyst (if the patient has recurrent multiple cysts and the GP has the necessary skills, then aspiration is acceptable)
  • Palpable or enlarged axillary mass including an enlarged axillary lymph node


  • If pain is associated with a lump
  • Intractable pain that interferes with a patient’s lifestyle or sleep and that has failed to respond to reassurance, simple measures such as wearing a well supporting bra, and common drugs
  • Unilateral persistent pain in postmenopausal women

Nipple discharge

  • All women aged   50
  • Women aged 50 with: Bloodstained discharge Spontaneous single duct discharge Bilateral discharge sufficient to stain clothes

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