Synopsis
Develop the ability to apply current NICE suspected-cancer referral criteria accurately, communicate the reason without implying a diagnosis and safety-net symptoms that fall outside automatic thresholds, while explaining uncertainty and arranging reliable review.
- Refer through the suspected-cancer pathway when a person aged 30 or over has an unexplained breast lump, whether painful or painless.
- Refer a person aged 50 or over for unilateral nipple discharge, retraction or another concerning nipple change under the NICE breast recommendation.
- Consider the suspected-cancer pathway at any age for skin changes suggesting breast cancer; NG12 does not attach an age threshold to this indication.
Reasoning priorities
Establish whether the feature is unexplained and matches a current criterion.
Record age, duration, laterality, pain, nipple and skin changes, pregnancy or lactation, infection features and prior imaging so triage can understand the concern.
Worked reasoning
A 33-year-old presents with a new unexplained painless breast lump. They ask whether lack of pain means it can safely be reviewed after several months.
- Take a targeted history and examine the breasts and nodes, documenting the lump site and any skin, nipple or systemic features that could affect triage.
- Match the case to NG12: age 30 or over with an unexplained breast lump qualifies for a suspected-cancer pathway referral with or without pain.
- Explain the referral in neutral terms, including that most assessed symptoms are not cancer but timely triple assessment is needed to establish the diagnosis.
- Send a complete referral containing relevant history, examination, accessibility and communication needs, and provide written information about the expected process.
- Verify electronic acceptance and appointment arrangements; safety-net rapid growth, new erythema, skin distortion, nipple bleeding or systemic deterioration.