Breast – benign and malignant

Useful Management Information
Minimum Referral Criteria

 Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)
  • Diagnosed breast cancer:
    • early (confined to breast)
    • locally advanced (spread to involve areas near the breast)
    • secondary spread (involving areas outside the breast e.g. lymph node
  • Inflammatory breast cancer (rare, involves lymphatic spread causing inflammation in the breast)
  • Recurrent breast malignancy
  • Suspicious lesion on breast screening mammography or FNAC
  • Suspicious breast mass on clinical examination
  • Ductal carcinoma-in-situ (non-invasive confined to the ducts)
  • Lobular carcinoma-in-situ (non-invasive confined to lobules)
    Breast lump
  • New diagnosis or clinically suspicious of primary breast malignancy (biopsy or mammogram proven)
  • New discrete lump
  • Young women with tender, lumpy breasts
  • Asymmetrical nodules that persist at review after menstruation
  • Older women with symmetrical nodules provided that they have no localised abnormality
  • Any lump that increases in size
  • Ductal papilloma
  • Cyst persistently refilling or recurrent cyst
  • New lump during pregnancy
          Breast pain
  • Continuous mastalgia
  • Localised areas of painful nodularity/ focal lesions
    Nipple discharge, nipple retraction, change in skin contour
  • Discharge sufficient to stain clothes
  • Blood stained discharge
  • Persistent single duct
  • Nipple retraction/distortion
  • Nipple eczema
  • Paget's disease of the nipple
Category 2
(appointment within 90 calendar days)
  • Benign breast disease for consultation
  • Low-risk breast lumps/cysts
  • Patient referred for screening for breast malignancy
  • Nipple discharge (non-blood stained)
  • Ductal papilloma
  • Fibroadenoma (diagnostic excision biopsy if diagnostic uncertainty)
  • Intermittent mastalgia i.e. hormonal
  • Gynaecomastia where there is substantial breast enlargement or significant breast tenderness and where breast size is disproportionate to body habitus
Category 3
(appointment within 365 calendar days)
  • Gynaecomastia
  • Prophylactic mastectomy

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be returned

  • Document details/duration symptoms
  • Document family history of breast cancer
  • Description of clinical findings
  • Medical management to date
  • Current USS/mammography results
  • Current FNAC or core biopsy results
  • Any previous relevant investigation results
  • Gynaecomastia require BMI
Additional Referral Information

Staging investigations e.g. Bone scan, CT scan

Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.