2. Exeter Breast Service
• Multidisciplinary
• 630 new breast cancer patients per
year
• All patients referred to one-stop clinic
are seen within 2 weeks
• All patients with breast cancer start
treatment within 31 days of diagnosis
3. Exeter Breast Service
Symptomatic patients Screening patient
Lister in Health
2 week wait CAB, DART
One stop clinic
4. NHS Breast Screening
Service
Aim - to reduce mortality by 25%
Women 50 - 70 years
3 yearly
Two view
Two readers
Palpable / impalpable
9. Eczema
• Is it Paget’s?
• Nipple or areola
• Trial of hydrocortisone
• Punch biopsy
10. Nipple retraction
• Needs investigation as cancer likely
• Slit-like inversion is usually benign
11. Redness
• Mastitis is painful
• Inflammatory breast cancer is usually
not
12. Breast pain
• Cyclical and bilateral usually benign -
What does the patient want?
• Persistent, new, unilateral, no trauma -
Investigate
13. Palpable axillary lump
• Node
Past history skin lesion
Breast triple assessment
Examine trunk and upper limb
• Ectopic axillary breast
Visible
Beneath skin
Not marble
14. Recent advances in surgery
• Sentinel node biopsy
• Intra-operative sentinel node PCR and
proceed
15. Recent advances in surgery
• Immediate reconstruction
• Breast reshaping following wide local
excision including lipofilling
16. Breast cancer treatment
• Multidisciplinary
• Combination of surgery, chemotherapy,
herceptin, radiotherapy, hormone treatment
eg tamoxifen, aromatase inhibitors
• Patient choice
• Comorbidities
• Trials
• Oncotype-DX
