The Exeter Breast Service is a multidisciplinary team that sees over 630 new breast cancer patients per year. All patients referred through the two week wait clinic are seen within two weeks and start treatment within 31 days of diagnosis. The service performs breast cancer screenings for women ages 50-70 every three years which involves two views of each breast read by two radiologists. Symptomatic patients may be referred for issues like breast lumps, nipple discharge, or skin changes and receive a triple assessment involving a physical exam, imaging, and biopsy. Recent advances include sentinel node biopsies, intraoperative PCR of sentinel nodes, and immediate breast reconstruction options. Treatment involves a multidisciplinary approach using combinations of surgery, chemotherapy

1. Exeter Breast Service
Julie Dunn
Consultant surgeon

2. 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

3. Exeter Breast Service
Symptomatic patients Screening patient
Lister in Health
2 week wait CAB, DART
One stop clinic

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!