EMBPP Key Components

The East Midlands Breast Pain Pathway (EMBPP) recommends that patients are seen away from a specialist breast unit and in a community or primary care setting.

Breast pain is not a symptom or sign of breast cancer, but for many years patients with troublesome breast pain have been referred into breast diagnostic clinics which may be a cause of unnecessary anxiety and investigation. Patients with breast pain seen in diagnostic one stop clinics will inevitably sit next to anxious patients with red flag symptoms for breast cancer such as breast lumps.

They are more likely to undergo unnecessary diagnostic procedures. An audit of patients with breast pain only seen at one stop diagnostic breast clinics at the University Hospitals of Derby and Burton prior to the introduction of the EMBPP showed that 80% of the patients had imaging (mammogram or ultrasound) carried out with all tests being normal. This has the potential to 'medicalise' patients with breast pain. They may assume that when they next have an episode of troublesome breast pain that they require referral for investigations to rule out breast cancer.

The other advantage of moving the patient with breast pain only away from the diagnostic clinics is the time that the clinician can spend with the patient, to give both reassurance and detailed advice regarding breast pain management. In a busy diagnostic clinic where the main aim is the diagnosis or exclusion of breast cancer there are inevitable other priorities and time pressures that may make that more difficult.

Moving patients with breast pain only away from the diagnostic one stop breast clinics will also free up capacity in those clinics to see and assess patients with more concerning symptoms for breast cancer more promptly.

The centres that have implemented the EMBPP to date have used a variety of setting away from their Breast Unit. These include accommodation at GP practices and Community Hospital sites examples of which are shown.

Sourcing community site settings to establish local breast pain clinics can be challenging. We have found that those services implementing the EMBPP as a collaborative project between primary and secondary care from the outset have been most successful. The Trust involved may have Community Hospital sites as part of their organisation. Primary care clinicians and managers will usually be able to identify suitable locations in their locality.

Holding breast pain clinics locally in the community may also have the advantage of reduced travel for patients attending these clinics, that can be nearer than their breast unit. An example would be in Staffordshire where patients from Tamworth (17 miles) and Lichfield (16 miles) would usually have to travel to Burton-on-Trent to the breast unit. They are now seen at the Community Hospitals in Tamworth and Lichfield. This also has potential environmental advantages.

Important factors to take into account when deciding on the placement of community breast pain clinic sites are public transport access (eg, bus routes) and ease of car parking.