NHG-standaard ‘Diagnostiek van mammacarcinoom (tweede herziening)’

In September 2008, the Dutch (NABON) practice guideline on breast cancer diagnosis and treatment was updated (www.oncoline.nl). Now the Dutch College of General Practitioners has issued a revised version of its practice guideline on breast cancer diagnosis as well. Of every three breast cancer patients, one is diagnosed by population-based screening, one by the general practitioner and one by others. In the national NABON guideline, referral to the breast team is recommended in cases with signs of malignancy or bloody nipple excretion and for patients above 40 years with a palpable mass (even without suspicion of malignancy) or with symptoms (previous dense mammogram). Referral to the radiology department is recommended in patients with symptoms but no physical abnormalities and in patients below 40 with a palpable mass, but without suspicion of malignancy. Family history is a standard part of the history-taking. Follow-up after the initial five years of diagnosis can be done by the general physician. The place of mammography (population-based screening or in hospital) depends on age and type of surgery. A good initiative in common cancers such as breast cancer is to have not just a one-size-fits-all guideline, but also concrete tailor-made solutions with recommendations for general practice. The general practice guideline contains different referral patterns and age criteria, however, to the national NABON guideline for localized palpable abnormalities without suspected malignancy and for breast lumps. These differences are according to the opinion of this article’s authors not advisable.