Department of Medical Photography

1
Cancers found at Breast Screening Is the
Radiologist giving the Surgeon all the
information needed in the referral letter?
Ridley N¹, Taylor S¹, Cook J-L¹, Coombs N², Galea
M², Gawad A², Radiology¹ and Surgical² Breast
Unit Great Western Hospital Swindon

INTRODUCTION In our breast unit cancers detected
at screening are assessed by the radiologist who
also gives the results to the patient. A standard
referral letter is then written to the breast
surgeon. This letter, in addition to being of use
to the surgeon, is also a helpful record for the
radiologist when the patient returns for
localisation. A copy of the letter is sent to the
GP and also given to the patient. We audited the
referral letters to see if all the necessary
information was present and if there was anything
else the surgeon required. METHOD 31 referral
letters were audited for the standard
information, including mammographic and
ultrasound findings. In addition information not
routinely given but wanted by the surgeon was
documented. RESULTS All three breast surgeons
found the letters helpful. However 16 of the
letters did not have complete information. In 10
of the letters the quadrant was not stated, in 4
axillary status was not documented and in 4
precise dimensions were not given. Additional
information not given in the standard letter but
wanted by the surgeon included lesion depth,
distance from muscle and nipple. CONCLUSION The
referral letters are important and a set format
will encourage all the information to be given.
We have changed our letters accordingly and will
re-audit.
The standard referral letter is computerised with
drop down boxes with set fields to ensure all the
data is included. In the specimen letter below
these are in red.
STANDARD REFERRAL LETTER Dear Mr X RE Patient
y Thank you for seeing this 54 year old lady who
came for screening recently. She was found to
have a suspicious 20 mm spiculated mass UOQ at 4
oclock, 60mm from the nipple in her right
breast. It lies at a depth of 13mm and is
separate from the pectoralis muscle. M5 US
demonstrated a suspicious mass that measured 22
mm U5 The abnormality is palpable. The axilla is
normal. An US guided biopsy was performed
showing invasive ductal carcinoma B5b. She was
discussed at the Breast MDM on the 22 October
2009 I have told her the diagnosis in the
presence of Sister Z specialist breast care
nurse. Her sister has been treated for breast
cancer 2 years ago and is well. Yours
sincerely cc GP patient
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