Breast

Breast Lumps and Lesions

My patient has incidental lesions reported on the ultrasound, is a biopsy required?

The need for biopsy of incidental lesions depends on their BIRADS category.

BIRADS (Breast Imaging Reporting and Data system) is used by radiologists to report how suspicious a breast lesion is. This is a useful link to the American College of Radiologists that explains these categories in detail: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads.

Solid lesions:

  • Any solid lesion that is deemed BIRADS-3 or over, should be considered for biopsy. Refer to a breast surgeon.

Cystic lesions:

  • Simple cysts are benign and classified as BIRADS-2. They do not need to be biopsied or followed up.
  • Complicated and complex cysts may require follow up or biopsy. Refer to a breast surgeon.

My patient has calcifications on mammogram. Do they need a biopsy?

Not all mammographic calcifications require biopsy. If they are BIRADS-3 or over, they should be considered for a biopsy. Refer to a breast surgeon.

Breast Cancer

How do you assess a woman’s risk of breast cancer?

Although it has some limitations, the Gail model is a helpful tool in assessing a woman’s breast cancer risk: https://bcrisktool.cancer.gov/calculator.html.

How do you assess the need for adjuvant chemotherapy and / or endocrine therapy for a woman with breast cancer?

This is a complex question and the answer is usually individualized and discussed in the context of a multi-disciplinary meeting (MDM). However, PREDICT is a useful tool in estimating the benefit of various adjuvant therapies in early breast cancer: https://breast.predict.nhs.uk/tool

What is shared care?

Shared care is the active involvement of the GP in breast cancer surveillance.

Visits alternate between the patient’s GP and the surgeon / medical oncologist.

This facilitates continued surveillance by the GP once the patient is ready to be discharged from specialist care.

What does a breast cancer surveillance visit involve?

  • History – weight loss, new bony or abdominal pain, new pulmonary or neurological symptoms.
  • Examination – Breasts, axillae, supraclavicular fossae, abdomen (for hepatomegaly) + targeted examination based on other symptoms.
  • Yearly mammogram (+ ultrasound if breast density is high – eg. younger / pre-menopausal patients).

How can my patient access cutting-edge treatment that may not be widely available?

In Australia, we are lucky to be able to provide the highest level of standardized care to our breast cancer patients across the country. New treatments are always evolving, however, and it can take years before trials conclude benefit. Despite this, it may be beneficial for some patients to access these medications by being part of these well controlled trials.

To find out which clinical trials are available for breast cancer in Australia, please follow this link:
https://www.breastcancertrials.org.au/current-clinical-trials

Patients can download an app which can help them find a suitable trial:
https://www.breastcancertrials.org.au/clintrial-refer-app

Where can my patient find more online resources on breast cancer?

Further patient information can be found on our website.

Below are links to useful websites for patient information:

Australian Guidelines

For more detailed guidelines on the management of breast cancer in Australia, follow this link:
https://canceraustralia.gov.au/publications-and-resources/clinical-practice-guidelines

Optimal Care pathways:
https://www.cancervic.org.au/for-health-professionals/optimal-care-pathways