Breast symptoms in general practice

Overview

Breast symptoms are among the commonest reasons women present to general practice, and the presenting symptom is almost always fear. The four presentations are a lump, breast pain (mastalgia), nipple discharge, and skin or nipple change. Benign disease dominates the caseload — in a consecutive series of 100 women with breast complaints, fibroadenoma accounted for 59%, fibroadenosis 19% and breast abscess 16% — but the consultation exists because cancer must be excluded, and the exclusion must be structured.^[22]

The structure is triple assessment: clinical examination, imaging, and tissue sampling, read together. Combined, the three components reach sensitivity of 99–100% with specificity around 99% across series.^[9][6] The GP's role is not to complete the triple assessment — imaging and biopsy are specialist-provided — but to recognise which symptoms need it, start it through the right pathway, and manage the large benign majority with evidence rather than reflex.^[15]

References28ShowHide

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