The presentation and management of female breast symptoms in general practice in Sheffield

Background. Relatively little is known about the incidence of breast symptoms in primary care consultations and GPs' patterns of referral to secondary care. Objective. We aimed to identify the consultation rate for breast symptoms in general practice and to describe the management of those symptoms, including patterns of referral to secondary care. Method. Prospective data were collected by 248 GPs concerning 508 women consulting for breast symptoms. A verification study was carried out in nine practices to compare the data collected prospectively with information recorded contemporaneously in the same patients' notes. Main outcome measures were number of patients with lump, pain, nipple discharge, skin or nipple problems, family history or other symptoms at first or subsequent consultation, management action, age of patient and number of patients meeting study criteria for whom GPs did not record information in the prospective study. Results. The mean number of consultations per GP over the 4-week recording period was 2.05. However, examination of a patient's notes from a sample of nine practices participating in the verification study suggested that GPs recorded only slightly over half of the consultations for breast symptoms on the study pro forma. At their first consultation, 40% of women presented with a breast lump and 40% with breast pain. Fifty-eight per cent of women with lumps were referred for specialist evaluation after a first or subsequent consultation, whereas the comparable percentage for women referred for pain was 17%. Conclusions. At an initial consultation for breast symptoms, GPs refer approximately one-third of women to secondary care. Women are most likely to be referred for a lump or for a family history of breast cancer and least likely to be referred for breast pain. The verification study suggests that relying on GPs to collect data on a specific group of patients may produce an underestimate of the consultation rates for a specified condition.