Mr Debashis Ghosh, Consultant Breast Surgeon at Check4Cancer’s OneStop Breast Clinic network, answers your questions and provides more detail on OneStop Breast Clinics.
What happens at a OneStop Breast clinic appointment?
A OneStop Breast Clinic appointment is a single consultation where someone with any suspicious breast symptoms is assessed by a certified and specialist consultant breast surgeon, in the presence of a clinical nurse specialist.
During the consultation, a full history and risk assessment is done, followed by a complete examination in the presence of a nurse. This allows all concerns related to the visit to be addressed. This is followed by sending the patient to radiology where a mammogram and ultrasound scan are performed based on the clinical needs of the patient. If the patient needs a biopsy, that is performed at the same time under ultrasound or mammogram guidance. All the results from the clinical examination and radiology are then discussed with the patient and a comprehensive management plan is provided by the consultant surgeon. Any further concerns the patient has are also discussed during this consultation.
If the patient has had a biopsy, they will have another consultation within the next five days via telephone or face-to-face to discuss the biopsy results. Further investigations and management will always be discussed, and advice provided during the consultation.
How long does the first appointment last?
A typical appointment is normally completed within two hours.
What are the benefits of having all the investigations done at my first appointment?
We are able to provide a normal diagnosis and reassure up to 90% of patients in one single visit. This means that patients do not have to return for a second appointment and are not left with lingering anxiety or concerns.
What does the clinical breast examination involve?
During a clinical breast examination, on an initial inspection, a visual check is done where the patient is checked for any changes in breast size or shape, abnormal skin changes, swelling under the armpits, and changes in size, colour or shape of the nipple. A further detailed examination of both breasts is performed by the consultant surgeon, to look for any presence of abnormal lumps, infection, discharge and swellings under the armpits.
What tests/investigations are carried out?
Based on the clinical needs and the requirements, all patients will usually have an ultrasound scan of the breast and all patients above the age of 35+ will be offered a mammogram. Those patients who need it will also have a biopsy taken under ultrasound or mammogram guidance.
What is a breast ultrasound?
A breast ultrasound is a scan which does not involve an X-ray and is very similar to scans performed during pregnancy. The scan helps us pick up normal and abnormal lumps in the breast using sound waves.
Will I need to have a mammogram?
If you are above the age of 35+ we recommend a mammogram. If you have a symptomatic lump that is found during the clinical examination, a mammogram is also done in addition to the ultrasound scan as it helps us to understand the type and characteristics of the lump.
What is a needle biopsy?
A biopsy is a way of taking a sample of breast tissue using a needle under ultrasound or mammogram guidance. The tissue sample is then examined in more detail to determine the exact diagnosis.
What happens next if signs of breast cancer are detected at my appointment?
The process of triple assessment, clinical examination, ultrasound/mammogram and needle biopsy carried out at your first appointment will help us to rule out or confirm a definite diagnosis of cancer.
If a diagnosis of breast cancer is confirmed then you will be referred for treatment, either to the NHS via your GP or alternatively by the private consultant breast surgeon who arranged your investigations.
How long do I have to wait for the results?
The earliest results can be obtained is 48 hours, and full diagnosis will be provided within five working days.
What are the most common problems that you see?
We observe a wide range of problems including breast lumps, breast pain, nipple discharge, family history of breast cancer, asymmetry, breast infections and problems with breast implants. Don’t be embarrassed if you have any concerns, it is important to get these checked as soon as possible.
I’m a man and I’m showing suspicious symptoms of breast cancer. What happens to me if I attend a OneStop Breast Clinic? How does it differ from a woman’s appointment?
You will be assessed in exactly the same way, but a mammogram may or may not be needed. We treat all breast lumps and symptoms in all people with equal importance.
Check4Cancer’s OneStop Breast Service
Check4Cancer’s OneStop Breast service provides you with access to fast track diagnostic investigations, without need for referral from your GP, if you think you may have developed recent symptoms of breast cancer. Book an appointment today if you’re concerned.
Mr Debashis Ghosh is the Clinical Lead and Consultant Breast Oncoplastic Surgeon, based at the Royal Free London hospital and UCL Medical School that is one of the leading Breast Units in the world.
His areas of expertise lie in treatment of breast cancer, screening, family history, benign breast disease, gynaecomastia, oncoplastic breast conservation, risk reducing surgery, revision, reconstruction, symmetrisation surgery, and intraoperative radiotherapy.
He is actively involved in breast surgery research including the pioneering use of a portable gamma camera for sentinel node biopsies. As a member of the Breast Team of the Royal Free and UCL Medical School, he is involved in trials in the use of intraoperative radiotherapy, radioactive iodine and seed localisation. He is currently working on the use of fluorescence in cancer surgery. He has several publications and has written the chapter on Breast Surgery in Kirk’s Operative Surgery.
Mr Ghosh underwent Higher Specialist Training in Breast and Oncoplastic Surgery at University Hospitals of Leicester, Addenbrookes Hospital Cambridge and Peterborough. He then completed a one-year post CCT Fellowship at the Royal Free Hospital London. He has also trained in leading European centres as a Visiting Fellow. He has the distinctive achievement of holding a dual qualification from the European Board of Surgery in Breast and Surgical Oncology.
