Clinics offered following GP referral

The New Patient Clinic – also called Triple Assessment clinic:

All patients with a breast related problem (excluding breast pain only) should be referred to a rapid diagnostic clinic for triple assessment.

Patients should allow up to 3 hours for this appointment as it will include:

·         Initial assessment and clinical examination

·         If imaging is required, this will be carried out on the day and if age 40 years and over this will include a mammogram (if not had within the last 6 months).

·         Tests carried out in the Breast Department:
Digital mammograms
This is a low dose X-ray examination of the breast which involves compression of the whole breast between two plates and lasts for only a few seconds.

·         Ultrasound scan
This is similar to the ultrasound used for pregnant women. It is a painless examination of the breast using sound waves instead of X-rays. The examination is performed whilst you are lying down, some jelly is applied to the skin and a probe passed over the breast to produce a picture.

·         MRI scan
A magnetic resonance imaging (MRI) scan is required for some groups of women who have been diagnosed with breast cancer and is also used in a number of other clinical situations, such as screening certain women who are at increased risk of developing breast cancer. It produces detailed images of the breast to help diagnosis.

·         Needle (core) biopsy
The small gauge needle biopsy is one procedure which allows a small sample of tissue to be retrieved from the breast tissue directed by X-ray or ultrasound guidance. This can be completed at the time of your attendance at a clinic under local anaesthetic (so you are awake).

·         Vacuum assisted core biopsy
This  is a procedure carried out either at the time of your attendance or as a booked appointment, using local anaesthetic. This biopsy retrieves tissue as with the needle biopsy but is vacuum assisted. This enables a slightly larger specimen to be taken and can help with diagnosis.

·         Vacuum assisted excision
Extensive use is made of vacuum-assisted excision (VAE) as an alternative to surgical removal for benign lumps in the breast. VAE is performed in the Breast Unit under local anaesthetic, the whole procedure only taking 30 to 40 minutes..

 

·         Fine needle aspiration
A thin, hollow needle is used to take a small sample of breast tissue which will be examined.

·         All imaging results will be given prior to you going home

·         If biopsies have been taken, results will take up to 7 days to be reported

·         Results will be given either via face to face consultation, over the telephone or in writing.

The majority of patients attending this clinic are reassured that no worrying abnormality has been found. The following are possible causes of benign (non-worrying) breast symptoms. Further information from Breast Cancer Now in links below:

·         Breast cysts 

Breast cyst

Duct ectasia 

Duct ectasia

Fat necrosis 

Fat necrosis

Fibroadenoma 

Fibroadenoma

Periductal mastitis: 

Periductal mastitis

 

Gynaecomastia clinic:

This is for male patients under age 50 with a breast related problem. Patients should allow 30 minutes for this appointment which will include:

·         Initial assessment and clinical examination

·         Discussion relating to findings on the day and future plan

·         If imaging is required, this will be requested and an appointment will be sent out in the post for a future date

·         Results of imaging will be in writing to the patient and copied to GP

·         Gynaecomastia usually is a benign (non-worrying) condition.Further information from Breast Cancer Now in link below:  

Gynaecomastia

 

Telephone Mastalgia (breast pain) clinic:

All patients referred with breast pain that DO NOT HAVE:

 A new lump; skin dimpling / change to breast shape; new in-drawing of nipple; clear / blood stained nipple discharge, should expect a telephone consultation with a Consultant, Associate Specialist or Advanced Nurse Practitioner.

·         Patients will receive an appointment letter which will provide the date and an approximate time for the telephone consultation to take place

·         Please ensure that the hospital has the correct contact number for you. If your phone number has changed, inform Breast Services prior to your appointment

·         If you are aged 40 years or over, you will be referred for a mammogram which will be carried out within 2 weeks following your telephone consultation

Breast pain is most commonly a completely benign (non-worrying symptom). Further information on possible causes and measures that can help can be found on Breast Cancer Now link below:

Breast pain

 

Family History clinic

Further information from Breast Cancer Now in link below:

Family history

The Family History Clinic is led by an Advanced Nurse Practitioner who consults with individuals who have concerns about their risk of developing breast cancer due to a family history. Individuals are assessed in line with current NICE guidance to try and identify if there is an inherited increased risk of developing breast cancer on the basis of their family history and given information and support relevant to their needs.

The treatment programme involves:

·    A family tree / pedigree is drawn up and other factors associated with risk are discussed.  These include age, gender, hormonal and lifestyle choices.

·    Appropriate surveillance in the form of MRI and / mammography is arranged on an individual basis.

·    Identification of high risk patients or those with a complex family history may necessitate further referral to the Regional Genetic Centre in Manchester for further counselling and discussion.

·    If breast cancer is diagnosed, the patient is referred to a consultant breast surgeon in the department.

 

Referrals

Referrals can be made by letter or via Choose and Book. Referral letters should be directed to:

Angela Duckworth
Advanced Nurse Practitioner (Family History Clinic)
Breast
Services, Evergreen Suite
Royal Bolton Hospital
Minerva Road
Bolton
BL4 0JR