Which patients with breast pain should be referred for further investigation, such as imaging or specialist assessment?

Patients presenting with breast pain should be referred for further investigation, such as imaging or specialist assessment, if they meet any of the following criteria:

• Women aged 30 years and over with an unexplained breast lump, with or without pain, should be referred urgently using a suspected cancer pathway referral (2-week wait) ³,⁵.
• Women aged under 30 years with an unexplained breast lump, with or without pain, should be considered for a non-urgent referral ³,⁵.
• Women aged 50 years and over with any of the following symptoms in one nipple only: discharge, retraction, or other changes of concern, should be referred urgently ³.
• Patients with skin changes suggestive of breast cancer or an unexplained lump in the axilla aged 30 years and over should be considered for urgent referral ³.
• Women with persistent breast masses, especially if there are clinical features of concern or uncertainty about the diagnosis, should be referred for specialist assessment to exclude breast cancer ²,⁵.
• Women with breast pain severe enough to affect quality of life or sleep and not responding to first-line treatment after 3 months may be referred to a breast specialist for further management ¹.
• Women with suspected breast abscess should be referred urgently to a general surgeon ⁵.

Reassurance and conservative management are appropriate for cyclical breast pain without concerning features, but persistent or suspicious symptoms warrant referral.