The outpatient consultation
At Sarum Road Hospital, I run a clinic specialising in breast problems usually
on a monday morning. Most people are referred by their general practitioner and
both men and women are seen. The clinic is run in tandem with a specialist
Consultant Radiologist, Dr Cheetham, so x-rays and ultrasounds can be performed
and analysed at the same session. Needle biopsy results are usually obtained the
same day and I will contact you with the results.
www.bmihealthcare.co.uk/sarumroad/
I can advise on all aspects of breast disease and concerns. I also see and
advise men who have problems in the breast and armpit area. I can also advise on
minor general surgery complaints such as lumps and bumps especially on the chest
and in the armpit.
For women with breast problems you will be asked at the consultation, about risk
factors for breast cancer such as age at which menstrual periods started and any
family history of cancer. I also ask about general medical problems and past
experience of anaesthetics. Please feel free to bring a friend, partner or
supporter.
A breast examination is then performed. This involves undressing to the waist
(including the bra). I then carefully inspect the breasts looking for colour
changes, distortion and dimpling. You are then asked to lie back on the
examination couch and I feel for lumps in each breast, the armpits and the area
above the collar bone. A nurse will be present for the examination.
A similar examination is performed for men with lumps in the breast area plus an
examination of the abdomen.
If a lump is found that needs further investigation, a needle biopsy can be
performed. This involves wiping the skin with antiseptic and inserting a slim
needle into the lump. If the lump is full of fluid (a cyst), the fluid can be
drawn off and no further intervention is required. If the lump is solid there is
a bit of jiggling to draw off cells to send to the lab for analysis. Local
anaesthetic is not required – it involves just as big a needle and stings for as
long as the test takes. Sometimes there is bruising afterwards, which can be
reduced by pressing firmly over the area. Some people do find this test painful
but most say it was better than they expected. The less anxious you are the less
painful it will be. You can always refuse the test but full reassurance may not
be possible without a needle biopsy.
I sometimes recommend a wide bore or core needle biopsy which is performed under
local anaesthetic and the results take about 48 hours to turn around. Discomfort
and bruising are common afterwards but usually mild and short lived.
Pain alone is very unlikely to represent a breast cancer but does draw attention
to the breasts. I can examine to see if there is an alternative origin for the
pain such as that originating from the chest wall joints or nerve roots. Pain
specific to a discrete area of the breast will need further investigation.
I follow NICE and NHS guidelines when referring for mammograms and ultrasound
examinations.
http://guidance.nice.org.uk/CG80/QuickRefGuide/pdf/English
Mammograms are x-rays of the breast which can pick up early stages of breast
cancer when there is no lump to feel. They can also help us to diagnose lumps we
can feel and plan operations. Mammograms are also useful for screening purposes.
They are available free on the NHS every 3 years after the age of 47-50 years
(you will be contacted) and yearly between 40 and 49 years for those at high
risk (you risk needs to be assessed in the clinic). For those at lower risk
there is some evidence from trials in the United States that mammograms every 2
years between 40 and 49 years confers a survival advantage and you can request
these checks through the radiology department at Sarum Road Hospital or your
local private healthcare provider.
www.bmihealthcare.co.uk/sarumroad/
Be warned- mammograms are not a perfect test. Some cancers will be missed by
mammography and sometimes we find “red herrings” that involve extra tests and
anxiety. Mammograms are not suitable for women under 35 years of age because of
reduced accuracy. Ultrasounds are not suitable for screening but are excellent
for specific problems such as diagnosing lumps.
http://www.cancerscreening.nhs.uk/breastscreen/
If the physical findings are not worrying, I will only order mammograms if there
is a specific need to do so or early screening mammograms are requested. If
there is a lump that we think is benign, we need to confirm this with a
mammogram or ultrasound and a needle biopsy. There is no need to remove lumps
that we have proven are benign but will do so if requested.
When the findings are unclear or more worrying, further tests may be requested.
These include; core needle biopsy, removing the lump under a local or general
anaesthetic or additional radiology tests.
A needle core biopsy takes a small slither of tissue from the lump and the
relationship of the cells to each other can be studied in the laboratory. The
laboratory needs at least 48 hours to process the specimen. We usually perform a
needle core biopsy under x-ray or ultrasound guidance or in the minor operating
theatre. You will have the area cleaned with antiseptic and local anaesthetic is
given. This freezes the area but stings as it is administered. The numbness
lasts for 2-4 hours. A small nick is made in the skin and the core needle is
passed into the lump and a number of samples are taken. The nurse assistant will
press over the area to reduce bruising. A small dressing will be applied. No
stitches are required. The main complications are bruising and some discomfort -
paracetamol can be taken for this. There is no need to avoid work or driving
after this procedure but do not drive if you feel shaky.
A letter about the consultation will be sent to your referring doctor and
general practitioner. Please feel free to request a copy for you own records. If
I know in advance I can interpret “medical speak”.
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