Direct to an emergency department for:

  • Breast abscess failing drainage
  • Lactational mastitis with systemic symptoms.

Criteria for referral to public hospital service

  • New palpable and persistent cyst(s) with complex features on imaging
  • Recurrent cyst(s) with complex features on imaging
  • Palpable, symptomatic, or growing fibroadenoma
  • Any one component of the triple test is positive (clinical examination, imaging or non-excisional biopsy)
  • Incomplete cyst aspiration, bloody aspirate (not traumatic) or a lump that remains post-aspiration
  • Spontaneous unilateral, bloody or serous discharge from a single duct, particularly if > 60 years
  • Eczematoid changes of the nipple-areolar skin for longer than two weeks that fails to respond to topical treatment
  • Inflammatory breast conditions not resolving after two weeks of antibiotic treatment.

Information to be included in the referral

Information that must be provided

  • Most recent mammography report or other breast imaging report(s) including when and where imaging was performed
  • Findings on physical examination
  • Details of previous medical management including the course of treatment and outcome of treatment
  • Relevant medical history and comorbidities
  • Any family history or genetic mutation linked to breast, ovarian or prostate cancer.

Provide if available

  • Core biopsy findings (location, size, type, histological grade and lymph node status) or fine needle aspiration (FNA) cytology results
  • Breast density
  • Current and complete medication history (including hormonal treatments, non-prescription medicines, herbs and supplements and recreational or injectable drugs)
  • Comprehensive past medical history
  • Details of any current issues that may impact on the person’s ability to attend a specialist clinic appointment
  • If the person identifies as an Aboriginal and Torres Strait Islander
  • If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Where a non-excisional biopsy is performed, core biopsy is preferable for the investigation of suspicious lesions. FNA cytology results may be used under limited circumstances where a core biopsy was not possible.

Vulnerable populations include:

  • people from culturally and linguistically diverse backgrounds
  • older Australians
  • carers of people with chronic conditions
  • people experiencing socio-economic disadvantage
  • people living in remote, or rural and regional locations
  • people with a disability
  • people with mental illness
  • people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

  • Single or multiple simple cysts
  • Fibrocystic breasts
  • Breast pain with normal imaging and clinical examination
  • No significant abnormality or benign findings on biopsy or imaging or both.