Update on breast cancer diagnosis and management: new topics for primary care

Over 49 000 women each year in the UK are diagnosed with breast cancer, making it the most prevalent cancer in women.¹ Most primary breast cancers in the UK are diagnosed through two routes. The NHS Breast Screening Programme (NHSBSP) offers mammography every 3 years to women between the ages of 50 and 70. The breast screening services diagnose about a third of breast cancers. The remaining two-thirds of patients with breast cancer present, generally, to primary care, with symptoms, including a breast lump, nipple discharge, breast pain, and nipple inversion. In the UK, demand for symptomatic breast services continues to increase annually, despite a relative plateau in the number of new cases of breast cancer diagnosed. From NHS Digital data (derived from Hospital Episode Statistics data), there were 612 619 first appointments at NHS breast clinics in 2017–2018, an increase from 591 800 in 2016–2017, and 583 676 in 2015–2016.²

Breast cancer survival depends on the stage of the disease at diagnosis, the treatment received, and the biology of the tumour. More than 90% of women diagnosed with early breast cancer survive for at least 5 years, and 78% survive for 10 years. In contrast, only 13% of those diagnosed with advanced disease survive for >5 years.

Currently, there are three topics of interest and changing practice in the area of breast cancer diagnosis and management that are relevant to primary care: the use of neoadjuvant chemotherapy; genomic markers and profiling in breast cancer; and breast implant-associated anaplastic large-cell lymphoma, a new disease entity.