STEP 2: Presentation, initial investigation and referral

The following signs and symptoms should be investigated:

  • a persistent new lump or lumpiness, especially involving only one breast
  • a change in the size or shape of a breast
  • a change to a nipple, such as crusting, ulceration, redness or inversion
  • a nipple discharge that occurs without manual expression
  • a change in the skin of a breast, such as redness, thickening or dimpling
  • axillary mass(es)
  • an unusual breast pain that does not go away.

Initial investigations include a triple test of the three diagnostic components:

  • medical history and clinical breast examination
  • imaging – mammography and/or ultrasound
  • non-excision biopsy – preferably a core biopsy.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



A patient with signs and symptoms that may suggest breast cancer should see a GP within 2 weeks.

Optimally, tests should be done within 2 weeks.

A positive result on any component of the triple test warrants specialist surgical referral. Ideally, the surgeon should see the patient with proven or suspected cancer within 2 weeks of diagnosis. If necessary, prior discussion should facilitate referral.