GPAtlas🧭 When to suspect
Breast cancer is the most common cancer in women in the UK, yet the great majority of breast symptoms seen in primary care are benign. The clinical task is therefore not to diagnose cancer in the consulting room – that is the work of the breast clinic – but to recognise who needs urgent assessment and refer them promptly.
Suspect breast cancer in anyone with a new, unexplained breast lump, an axillary lump, or skin or nipple changes. Most malignant lumps are painless, but pain does not exclude cancer. The single most useful framework is the NICE NG12 referral criteria, driven almost entirely by age and symptom.
| Presentation | Action |
|---|---|
| Unexplained breast lump, aged ≥ 30 (with or without pain) | Suspected cancer pathway (2-week-wait) referral |
| Discharge, retraction or other concerning change in one nipple only, aged ≥ 50 | Suspected cancer pathway (2-week-wait) referral |
| Skin changes that suggest breast cancer (any age) | Consider suspected cancer pathway referral |
| Unexplained lump in the axilla, aged ≥ 30 | Consider suspected cancer pathway referral |
| Unexplained breast lump, aged < 30 | Consider non-urgent referral |
Risk rises with age and is increased by a family history of breast or ovarian cancer (including BRCA1/2 and Ashkenazi Jewish ancestry), prolonged oestrogen exposure (early menarche, late menopause, nulliparity, combined HRT), previous chest-wall radiotherapy, and lifestyle factors such as alcohol and postmenopausal obesity.
Source: NICE NG12 · NHS Breast Screening Programme
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