The NHS has received new guidelines that downplay breast pain being a sign of cancer.
Breast cancer referral forms to NHS nurses outlines the changes. 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’.
In breast cancer referral forms, sent to NHS medical staff, the changes are outlined. 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’
Experts are divided on the guidance. It follows concerns that women who have not been diagnosed with cancer may be referred to busy clinics for breast surgery.
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.’
According to him, the referral forms didn’t make it clear enough that women with pain in their breasts should be urgently referred or that women might have pain in both of their breasts due to two reasons.
Ian Smith was professor of cancer medicine at Royal Marsden Hospital as well as the Institute of Cancer Research. He supported this 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.’