GP referrals

We hold a clinic for people referred by their GP also known as symptomatic patients – every weekday at Musgrove Park Hospital in Taunton.

The clinic team includes breast surgeons, breast radiologists and breast advanced nurse practitioners. During the clinic we will take your medical history and examine you. If appropriate we will take images of your breast area, using a mammogram (X-ray) or ultrasound or both. Breast MRI scans if required cannot be done on the same day and you will need to return at a later date. Sometimes we need to carry out a biopsy, which is a small sample of your breast tissue so we can examine it more closely under the microscope.

This clinic can take up to three hours to complete. If you don’t need a biopsy, we may be able to give the results of the breast imaging on the day. If we take a biopsy, we will give the results of this up to 10 days later, either by post or at another appointment.

Screening assessment

This follow-up clinic is an assessment clinic for people who have had a breast screen and are invited back for further . At the clinic we will carry out more tests including a clinical examination, mammograms (X-rays) at different angles or with magnification, or an ultrasound.

About five out of every 100 people who have had screening will need to come to this clinic. However, it is part of routine screening and for most women invited back, we won’t find anything of concern.

Results

We hold two different results clinics each week.

Thursday afternoon: we will invite you to this clinic if you’ve had a biopsy after being referred by your GP and the results indicate you need cancer treatment. Please note; whilst we are delivering our services alongside Covid-19 some of these appointments are taking place by telephone.

Friday morning: we will invite you to this clinic if you have had a biopsy at our screening follow-up assessment clinic and the results indicate you need cancer treatment. Please note; whilst we are delivering our services alongside Covid-19 some of these appointments are taking place by telephone.

Before we invite you to either clinic, your results will have been studied and discussed carefully by a multi-disciplinary team including surgeons, pathologists, specialist nurses, oncologists, radiologists and radiographers.

At both clinics we will draw up a plan with you and outline the next steps, which may include surgery and referral to a specialist team. We will spend time with you and explain how the treatment options work and answer any questions or concerns you have.

The breast care nurses are able to follow-up this results appointment with a telephone or face to face appointment to continue to support you through this treatment pathway.

Family history

Many people have concerns about a family history of breast cancer, although only a small number of cancers are inherited. Most of the people we see in this clinic are women who have been to their GP with concerns about the risk of breast cancer to themselves and their children and would like a genetic test or early breast screen.

Once your GP has referred you we will send you (via your GP) a questionnaire asking for information about all your relatives, types of cancer in the family and at what age your relatives were diagnosed with the disease. We will also you for your own perception of your risk and what questions or concerns you would like to talk to us about in the clinic, which is led by a specialist radiographer and a specialist breast care nurse.

We will assess your completed questionnaire against national guidelines. If we don’t feel you or your family are at increased risk, we will send you some helpful information and we won’t offer you an appointment at the clinic.

If you do feel you and your family are at increased risk, we will offer you an appointment which will last around 40 minutes. Please note that we are currently only offering telephone appointments due to Covid-19.

During it we will:

• talk through your risk assessment in more detail and draw up a family tree
• discuss any specific concerns with you
• give you information about breast awareness, breast cancer and lifestyle factors
• offer you a clinical breast examination
• offer you mammogram (X-ray), if you are over 40 and it is clinically appropriate
• discuss the use of drugs to reduce breast cancer risk.

Women fall into two broad risk categories: moderate or high.

Women at moderate risk will be offered:

• early annual breast screening from the age of 40-49
• potentially, Tamoxifen for five years.

Women at high risk will be offered:

• early breast screening from the age of 40, plus more frequent screening after they are aged between 50-59
• a referral on to the clinical genetics department for possible genetic testing if appropriate
• Tamoxifen or Anastrazole for five years.

Where appropriate, we will refer you on to the regional clinical genetics service who may test you for the breast cancer genes. In this case your care will be continued jointly by both the family history service and the clinical genetics service and you may be offered breast screening with MRI scans as well as mammograms by the NHS breast screening service. In some cases and only where clinically appropriate, we will offer you risk-reducing surgery with breast reconstruction.