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  • 1. Exeter Breast Service Julie Dunn Consultant surgeon
  • 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. Exeter Breast Service Symptomatic patients 2 week wait CAB, DART One stop clinic Screening patient Lister in Health
  • 4. NHS Breast Screening Service Aim - to reduce mortality by 25% Women 50 - 70 years 3 yearly Two view Two readers Palpable / impalpable
  • 5. Symptomatic referrals • • • • • • • • Breast lump Skin dimpling Nipple discharge Eczema Nipple retraction or inversion Redness Pain Axillary lump
  • 6. Breast lump - benign • • • • • Discrete “marble” or “pea” Comes and goes Previous cysts Mobile No dimpling
  • 7. Skin dimpling • • • • Breast cancer Fat necrosis Previous surgery Mondor’s syndrome
  • 8. Nipple discharge needs investigation if: • • • • Unilateral Single duct Clear Bloodstained
  • 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
  • 17. Exeter Breast Clinics • Happen every day except Monday • You are all very welcome!