Exeter Breast Service

Julie Dunn
Consultant surgeon
Exeter Breast Service
• Multidisciplinary
• 580 new breast cancer patients per
year
• All patients referred to onestop cli...
Exeter Breast Service

Symptomatic patients

2 week wait

CAB, DART

One stop clinic

Screening patient
Lister in Health
NHS Breast Screening
Service
Aim - to reduce mortality by 25%
Women 50 - 70 years
3 yearly
Two view
Two readers
Palpable /...
Symptomatic referrals
•
•
•
•
•
•
•
•

Breast lump
Skin dimpling
Nipple discharge
Eczema
Nipple retraction or inversion
Re...
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 discharge
needs 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 I...
Palpable axillary lump
• Node
Past history skin lesion
Breast triple assessment
Examine trunk and upper limb
• Ectopic axi...
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 lipofilli...
Breast cancer treatment
• Multidisciplinary
• Combination of surgery, chemotherapy,
herceptin, radiotherapy, hormone treat...
Exeter Breast Clinics
• Happen every day except Monday
• You are all very welcome!
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Medical students

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Medical students

  1. 1. Exeter Breast Service Julie Dunn Consultant surgeon
  2. 2. 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
  3. 3. Exeter Breast Service Symptomatic patients 2 week wait CAB, DART One stop clinic Screening patient Lister in Health
  4. 4. NHS Breast Screening Service Aim - to reduce mortality by 25% Women 50 - 70 years 3 yearly Two view Two readers Palpable / impalpable
  5. 5. Symptomatic referrals • • • • • • • • Breast lump Skin dimpling Nipple discharge Eczema Nipple retraction or inversion Redness Pain Axillary lump
  6. 6. Breast lump - benign • • • • • Discrete “marble” or “pea” Comes and goes Previous cysts Mobile No dimpling
  7. 7. Skin dimpling • • • • Breast cancer Fat necrosis Previous surgery Mondor’s syndrome
  8. 8. Nipple discharge needs investigation if: • • • • Unilateral Single duct Clear Bloodstained
  9. 9. Eczema • Is it Paget’s? • Nipple or areola • Trial of hydrocortisone • Punch biopsy
  10. 10. Nipple retraction • Needs investigation as cancer likely • Slit-like inversion is usually benign
  11. 11. Redness • Mastitis is painful • Inflammatory breast cancer is usually not
  12. 12. Breast pain • Cyclical and bilateral usually benign What does the patient want? • Persistent, new, unilateral, no trauma Investigate
  13. 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. 14. Recent advances in surgery • Sentinel node biopsy • Intra-operative sentinel node PCR and proceed
  15. 15. Recent advances in surgery • Immediate reconstruction • Breast reshaping following wide local excision including lipofilling
  16. 16. Breast cancer treatment • Multidisciplinary • Combination of surgery, chemotherapy, herceptin, radiotherapy, hormone treatment eg tamoxifen, aromatase inhibitors • Patient choice • Comorbidities • Trials • Oncotype-DX
  17. 17. Exeter Breast Clinics • Happen every day except Monday • You are all very welcome!

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