Exeter Breast Service

Julie DunnConsultant surgeon

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

Exeter Breast Service

Symptomatic patients

Screening patient

Lister in Health

2 week wait CAB, DART

One stop clinic

NHS Breast Screening Service

Aim - to reduce mortality by 25%Women 50 - 70 years3 yearlyTwo view Two readersPalpable / impalpable

Symptomatic referrals

• Breast lump• Skin dimpling• Nipple discharge• Eczema• Nipple retraction or inversion• Redness• Pain• Axillary lump

Breast lump - benign

• Discrete “marble” or “pea”• Comes and goes• Previous cysts• Mobile• No dimpling

Skin dimpling

• Breast cancer• Fat necrosis• Previous surgery• Mondor’s syndrome

Nipple dischargeneeds investigation if:

• Unilateral• Single duct• Clear • Bloodstained

Eczema

• Is it Paget’s?

• Nipple or areola

• Trial of hydrocortisone

• Punch biopsy

Nipple retraction

• Needs investigation as cancer likely

• Slit-like inversion is usually benign

Redness

• Mastitis is painful

• Inflammatory breast cancer is usually not

Breast pain

• Cyclical and bilateral usually benign -

What does the patient want?

• Persistent, new, unilateral, no trauma -

Investigate

Palpable axillary lump

• NodePast history skin lesionBreast triple assessmentExamine trunk and upper limb

• Ectopic axillary breastVisibleBeneath skinNot marble

Recent advances in surgery

• Sentinel node biopsy• Intra-operative sentinel node PCR

and proceed

Recent advances in surgery

• Immediate reconstruction

• Breast reshaping following wide local excision including lipofilling

Breast cancer treatment

• Multidisciplinary• Combination of surgery, chemotherapy,

herceptin, radiotherapy, hormone treatment eg tamoxifen, aromatase inhibitors

• Patient choice• Comorbidities• Trials• Oncotype-DX

Exeter Breast Clinics

• Happen every day except Monday

• You are all very welcome!