Faster diagnostic pathways: Implementing a timed breast cancer diagnostic pathway: guidance for local health & social care systems

In March 2024, NHS England published guidance on the implementation of ‘Best practice timed diagnostic pathways’ for breast services which states:

‘Breast pain as a sole symptom is rarely a presenting feature of breast cancer, occurring in approximately 70% of women. It is not a sign of cancer but can take many months to resolve.’

Key points from the guidance:

• mandates triage of all referrals and diversion of patients away from the one-stop clinics for those at low risk of a cancer diagnosis who do not have red flag symptoms.
• aims to make best use of the one-stop clinic for those who need examination, imaging, and potential biopsy.
• ensures that those at low risk are seen in an appropriate setting and avoid the unnecessary imaging that often occurs in the one stop clinic. Most of these patients can be seen by a single clinician, and do not need the multidisciplinary resource of the one-stop clinic.’

Breast pain pathways

• Cancer alliances should ensure that any pathways set up to manage patients with breast pain …meet the needs of those patients and are delivered in the most clinically appropriate setting.
• Although not on a suspected cancer pathway, these referrals should still be able to expect an outcome within 28 days of initial referral.
• Non-suspected cancer pathways should maintain close links into one-stop clinic services and refer any patients on the pathway that present with red-flag symptoms.
• In the presence of a normal examination patients can be reassured and may not need imaging.
• Named clinical leadership and clear lines of accountability
• New breast pain pathways should maximise patient satisfaction, safety, and cost-effectiveness
• New pathways for breast pain management should be evaluated to ensure safety and patient satisfaction 

The East Midlands Breast Pain Pathway fulfils all of these requirements 

Link to full guidance:

NHS England » Faster diagnostic pathways: implementing a timed breast cancer diagnostic pathway: guidance for local health and social care systems