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Will new guidelines mean GPs miss breast cancers?

NHS doctors have been given new guidance downplaying a type of breast pain as a potential sign of cancer.

The change is outlined in breast cancer referral forms sent to NHS medics. The documents say that women who complain of pain in both breasts – ‘bilateral breast pain’ – ‘do not need urgent referral to a breast clinic’ but should be considered for ‘non-urgent referral’.

Medics are advised to show patients a leaflet, produced by the charity Breast Cancer Care, which reassures women that ‘in most cases breast pain will be the result of normal changes in the breasts’.

The change is outlined in breast cancer referral forms sent to NHS medics. The documents say that women who complain of pain in both breasts – ‘bilateral breast pain’ – ‘do not need urgent referral to a breast clinic’ but should be considered for ‘non-urgent referral’

The guidance, which follows concern that healthy women are being referred to busy breast clinics despite being at very low risk of cancer, has divided experts.

Kefah Mokbel, a surgeon at the private London Breast Institute at Princess Grace Hospital, warned it risked perpetuating the ‘widespread misconception’ that breast pain was not a sign of cancer.

‘That view is unfortunately held by the public, by some GPs and by some breast clinic staff,’ he said. 

‘One of the most common reasons for the late diagnosis of breast cancer is that the woman had breast pain, but it was ignored by her doctor. In a study of 500 women with diagnosed breast cancer, 18 per cent said they felt pain at the site of the cancer before the lump was detectable.’

He said the referral forms did not make it sufficiently clear that women experiencing pain in one breast should be referred urgently or take into account that a woman might be suffering pain in both breasts for two different reasons.

But Ian Smith, professor of cancer medicine at the Royal Marsden Hospital and the Institute of Cancer Research, backed the guidance. 

‘I think the change is sensible, as the chance of having pain in both breasts, caused by separate tumours, is very small,’ he said.

‘Bilateral pain is very common and almost always nothing to do with cancer. Clinics are extremely busy and we must concentrate on those at higher risk of cancer.’

Dr Jane Fryer, a London NHS medical director, said that despite the new guidance on bilateral pain, ‘the referral pathway’ itself for such women ‘has not changed’, adding: ‘All women continue to be referred to and assessed at an NHS breast clinic, and those with additional risk factors or symptoms of breast cancer will be seen urgently.’