Diagnosis

The following investigations should be undertaken:

• breast imaging tests including bilateral mammography and ultrasound (or MRI in selected cases)
• ultrasound of the axilla (including fine-needle aspiration of nodes if the axillary ultrasound is abnormal)
• breast core biopsy, if not already undertaken, which allows breast cancer receptor profiles (ER, PR, HER2) to be determined.

Staging investigations for distant disease

Staging is appropriate for patients with confirmed locally advanced or nodal disease and for any patient with clinical symptoms or clinical suspicion of metastatic disease.

Germline genetic testing

For detailed information and referral guidelines for breast cancer risk assessment and consideration of genetic testing, read eviQ’s Referral guidelines for breast cancer risk assessment and consideration of genetic testing.

Treatment planning

Ideally, the multidisciplinary team should discuss all newly diagnosed patients with breast cancer before surgery or neoadjuvant chemotherapy.

Refer to a breast cancer nurse within 7 days of a definitive diagnosis.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from multidisciplinary meetings (MDMs).

Checklist

Timeframe

Diagnostic investigations should be completed within 2 weeks of the initial specialist consultation.