Exeter Breast Service

Julie DunnConsultant surgeon

Exeter Breast Service

• Multidisciplinary• 580 new breast cancer patients per

year• All patients referred to onestop

clinic are seen within 2weeks• 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!