Generally, your GP refers you to a one stop clinic, or it could be a patient self-referral through your private insurance provider, or because you are self-funding.
The One-Stop Rapid breast clinic is a dedicated clinic aimed at evaluating all breast health and is designed to reassure and inform women about any breast problem.
It is supported by a multidisciplinary team comprising a surgeon, radiologist and nurses. A Specialist Breast Care Nurse is also present.
Breast problems can relate to anything deemed to be “worrying” by the patient, including second opinions and advice on previous cosmetic surgery involving implant augmentation or breast reductions. Most commonly, women present to the One-Stop with a lump or breast pain in 70-80% of cases.
What happens at the One-Stop Rapid Diagnosis Breast Clinic?
On arrival, you go to the reception, where your details will be taken/confirmed.
A surgeon will meet with you first in most cases to ask you questions that relate to your current concerns, your previous breast history, medications, family history and previous breast surgery, including implants, hormone replacement therapy (HRT), the contraceptive pill and your personal risk factors.
Your surgeon will then physically examine you carefully including both breasts, sometimes the armpits (lymph nodes) and other areas (around the neck). Often your surgeon is providing you with information during each phase of the consultation and may already be reassuring you or highlighting a clinical concern.
Normally you can take a partner/friend, but during Covid-19, there are restrictions in certain hospitals. Please ask the hospital before taking a partner/friend with you.
Every Rapid Diagnosis One-Stop should provide breast imaging at the same time to complete a thorough examination, and provide a definitive diagnosis. This usually occurs after the surgeon’s consultation.
After your examination you will have one or more of the following:
Mammogram - is a high quality digital X-RAY that screens both breasts and will always be performed in women 40 years and older, and occasionally in younger women if there is a concern, a high-risk family history or other risk factors.
Ultrasound - is based on sound waves and it provides more information specifically on any particular lump, breast density or focal breast pain. It is the only breast imaging performed in most women under 40 years.
Ultrasound is used together with mammograms in all women over 40 years with a lump or focal area of pain. It doesn’t replace mammograms in women over 40 years.
MRI or 3D-Tomosynthesis - Additional breast imaging may be required in certain diagnoses such as certain types of breast cancer called invasive lobular cancer, high grade microscopic intraductal breast cancer called DCIS, and where there is more than one cancer in the breast called multifocal cancers.
Needle (core) tissue biopsy - is performed using an ultrasound to guide the needle biopsy and occurs if there is a solid lump. It is performed in the one stop clinic and the results are available within 72 hours up to 7 days.
Fine needle biopsy (FNA) - may be used to aspirate or draw fluid out of a cyst. A cyst is a benign fluid-filled lump, that develops from aging thin walled breast ducts that dilate and form cysts. This procedure is simple and quick and is deemed not painful.
It is mostly unnecessary to test cyst fluid, unless the cyst contains a solid component or bloody fluid.
Results from all imaging tests occur on the same day as part of RAPID re-assurance. If there is any concern regarding the breast tests, your surgeon will need to see you with all the results to be able to recommend a personalised treatment/management plan in a follow up consultation within a few days.
The whole process for the One-Stop Rapid diagnosis clinic normally takes about an hour to two hours, depending on the tests.
Follow-up clinics may be necessary. This will be discussed during the consultation.
Common breast problems found at a One-Stop Rapid Diagnosis Breast Clinic
Breast abscess - Can be mainly associated with breast-feeding.
Cysts - Harmless, pockets of fluid that can be drained by fine needle aspiration.
Lumpiness of the breast - normal breast duct tissue that may come and go during the cycle, and is most common just before your period.
Fibroadenoma - Harmless, smooth, movable lump that usually occurs in younger women.
Mastalgia - Breast pain that often occurs at certain times in the monthly cycle (usually just before your period) or can occur at any time. It is most common in women between the ages of 30 - 50 and is very rarely associated with breast cancer.
Breast duct problems - the ducts (small drainage tubules leading to the nipple) can get enlarged and inflamed, hot and painful (mastitis). There may be a discharge from the nipple and sometimes a breast abscess.