Is it safe to allow general practitioners open access to breast imaging?

Many departments in the UK do not allow general practitioners open access for breast imaging. Royal College of Radiologists guidelines [1] published in 1999 recommend that direct referral of women by general practitioners for breast imaging should be controlled so that women with conditions requiring referral to a breast surgeon [2] are not inappropriately managed. To avoid overwhelming the already busy symptomatic breast clinics in Leeds, it was decided that direct access for breast imaging should continue but be audited.

Between May 2000 and April 2001, 491 patients were referred with a variety of symptoms, including 173 women with mastalgia and 130 women with a palpable lump. If imaging was normal, then the report advised referral to the breast clinic if the palpable abnormality persisted. Women with a mammographic or ultrasound abnormality requiring biopsy were recalled by the imaging department and 22 women underwent needle biopsy. All attended the next breast clinic for clinical examination and discussion of their results. Three cancers were diagnosed but none presented with a palpable lump. Open access for breast imaging is safe if controlled.