WVT Mastalgia clinic – information for GPs

Wye Valley NHS Trust’s Breast Team has launched a Breast Pain (Mastalgia) Clinic to help better manage what is a quite common condition which often causes unnecessary anxiety for patients.

The new clinic will help to reduce this unnecessary anxiety.

A referral to the Breast Team will naturally raise concern. The reality is that these referrals, where breast pain is the main symptom, rarely lead to diagnosis of cancer. This new clinic will reduce the number of referrals and therefore reduce the number of patients experiencing unnecessary worry and concern.

At present, more than 20 per cent of referrals to the breast clinic have breast pain as the main symptom. This new clinic will help reduce this and is in addition to the existing 2WW breast cancer referral clinics which will continue.

A similar scheme running in Mid-Nottinghamshire revealed that a lack of family history assessments contributes to missed opportunities for early detection and treatment of breast cancer. This may be true for Herefordshire.

The new clinic - which is being trialled in response to an initiative by the Expert Advisory Group to de-medicalise breast pain - will allow us to align our pathway with NICE guidelines which suggest that initial management is undertaken in Primary Care. This includes a basic assessment of family history.

Broadly, the benefits of the service are:

• An improved experience for patients with breast pain – reduced unnecessary anxiety
• Reduced repeat GP attendances in the long run
• Reduced unwarranted referrals to the breast clinic
  • Improved early detection of significant breast cancer family history

The clinical criteria for referral are:

• Patients who remain unassured after assessment by a GP or continue to be symptomatic
• Recurrent GP attendances with breast pain as the predominant symptom

What it means in practice

The majority of women presenting purely with pain should be managed initially at Primary Care level, reviewed at six weeks and if the symptoms have not begun to settle or they continue to be anxious despite reassurance, are referred via the new breast pain referral system to our Mastalgia Clinic.

A small subset of women, who on initial assessment are found to have signs of possible cancer or are in the moderate to high risk family history group, should be referred to our fast track clinics via the usual 2WW pathway.

All of this is made clear in our mastalgia referral pathway which can be viewed by following THIS LINK

Referral mechanism:

Referral will be via the Electronic Referral System (ERS) which is similar to the current 2WW referral proforma, although there will be a separate referral template for this clinic which will be available via EMIS.

To help you understand the new pathway and the expectations on Primary Care, we have put together a series of videos which will help you understand when to refer, how to refer and what happens in the clinic, as well as the follow-up plan.

• Introduction: FOLLOW THIS LINK
• Mastalgia demystified: FOLLOW THIS LINK
• Referral of patients to Mastalgia Clinic: FOLLOW THIS LINK

The clinic will run every other week to fulfil the 2WW criteria and will take place at the MacMillan Renton unit (MRU) at Hereford County Hospital.

It will initially be run on a trial basis for six months with a robust clinical governance structure in place to audit our results and patient satisfaction with the pathway. We will then share our results with you with a view to improving the model as we progress.

If you need more information, please contact Mr Kaustuv Das, Consultant Breast Surgeon, at Hereford County Hospital – 01432 364024, or via email: kaustuv.das@wvt.nhs.uk