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.