HNY Policy and Pathway Repository - Humber

These forms are only to be used for referrals with a high risk of cancer.  To assist you in evaluating the potential risk for cancer the QCancer assessment can be beneficial. QCancer has been developed for the UK with risk algorithms.  This tool will only provide a level of risk of cancer and is not a diagnosis tool.

Our commissioned acute providers have asked that you bear in mind when sending in a 2 week wait referral to check:

1. Has it been explained to the patient that this referral is for investigations that could lead to a cancer diagnosis?
2. Have you checked that the patient will be available in the next 14 days to attend an appointment?
3. Have you provided the patient with further information about the appointment? A leaflet is available in additional documents
4. Check patient’s contact details are up to date

Please complete all referral forms sections and Fax to: 01482 675505

The Central Referral Point telephone number is: 01482 604308

Electronic referrals can be made via the NHS e-Referal system. Services for a 2 week wait, suspected cancer are found by searching on speciality for 2ww and then selecting the clinic type i.e. 2ww Breast.  The referral can be made with GP system templates and please note a referral letter is no longer required with this proforma

Referrals will be accepted for both males and females, as well as those under the age of  30 or 35 years.

his form is only to be used for referrals with a high risk of cancer - this applies to male and female patients and includes those under the age of 30 years.  The below information is taken from NICE guidance.

• Age ≥ 30 with unexplained breast lump (with or without pain)
• Age ≥ 30 with unexplained lump in axilla
• Age ≥ 50 with any symptoms below in ONE nipple
  • Discharge
  • Retraction
  • Other changes of concern

Any age - Skin changes that suggest breast cancer

Other referrals should be made on the basis of the following guidelines via a standard referral letter.

1. Urgent Referral - Breast abscess / acute mastitis, single discrete lump (over), recurrent cyst in patients with a history of breast cysts, new defined area of nodularity that persists or increases.
2. Non-Urgent Referral - Breast pain, unresponsive to evening primrose oil or analgesia, bilateral or multi-duct nipple discharge, severe patient anxiety, family history.

Medical history / drugs / allergies

Has patient been informed of the reason for the referral?

HEYHT patient information leaflets