Breast Cancer

Breast cancer is the most common (non-skin) cancer affecting women in Scotland, with more than 5,000 new cases each year. Breast cancer is much less likely in men, with approximately 40 cases per year in Scotland.

Incidence rises from age 30 in women (>99.5% cases are in women aged 30 yrs or over) and from age 45 in men (>90% of new cases are in men aged 45 or over).

Most breast cancers are diagnosed at an early stage (1 or 2). Stage distribution differs by deprivation, with women living in more deprived areas being more likely to experience an advanced stage breast cancer diagnosis.

There are several risk factors for breast cancer:

• Significant family history of breast cancer or an inherited genetic alteration
• A previous diagnosis of breast cancer
• Early menarche (before age 11)
• Oral contraceptive use or hormone replacement therapy
• Older age at first giving birth (35 years or over)
• Nulliparity
• Not breastfeeding
• Older age at menopause (50 years or over)

The risk of breast cancer is also two to four times higher in women with previous false-positive breast screening results

There is evidence suggesting that first-generation Black African and Black Caribbean women in the UK who were diagnosed with symptomatic breast cancer had lower symptom awareness and faced barriers which resulted in delayed help-seeking.

Published data has shown that transgender women have a higher risk of breast cancer compared to men, and transgender men have a lower risk of breast cancer compared to women. In transgender women the risk of breast cancer is associated with hormone treatment. In cases of gender reassignment, it is important to provide sensitive and clinically appropriate care depending on individual circumstances and considering any hormone therapy involved.

(Scottish Referral Guidelines for Suspected Cancer July 2025)

Referral / Diagnosis

Breast cancer usually presents with a narrow symptom signature, meaning that most people present with only a few specific symptoms such as a breast lump and typically have short diagnostic intervals. For guidance on diagnosis please see individual symptom pages including:

• Breast Abscess 
• Breast Disease in Men 
• Breast Lump Breast Pain 
• Breast Skin Changes
• Nipple Symptoms
• Axillary Symptoms

The rest of this page collates information that may be helpful for Primary Care when caring for those who have a current diagnosis of Breast Cancer or who have a PMH of Breast Cancer.

Sources of Information and Contact for Primary Care and Patients

• Edinburgh Cancer Centre website: has details of the Edinburgh Breast Unit, and also the Clinical Nurse Specialists, Medical Oncology, Clinical Oncology and Radiotherapy Department
• Cancer Navigation Hub: Patients with Breast Cancer are provided with the number for the Cancer Navigation Hub. Calls can be directed to the most appropriate care team including the Breast Cancer Nurses. The Cancer Navigation Hub can be accessed by calling 0300 123 1600 (Monday to Friday 9am to 4pm, excluding most public holidays).

Post Surgical Complications

After surgery for Breast Cancer all patients are given information on possible post-surgical issues e.g. seroma, post-surgery lumps, infection. In this information all patients are provided with contact numbers for initial phone triage, and they can then be seen in clinic if indicated. If a patient presents to Primary Care then they can still be directed to call the numbers they have been provided with to seek review. If a professional to professional conversation is required then please contact the EBU via the contact details on the Breast Disease landing page.

Radiotherapy Breast Cancer Skin Changes

Guidance has been developed for patients with post Radiotherapy Skin Changes after Radiotherapy treatment for Breast Cancer. The guidance can be found here on RefHelp, and includes details of how patients can contact secondary care for further support if needed.

Endocrine Treatment of Breast Cancer

Endocrine treatment for Breast Cancer can be complicated and protocols do change as the evidence base changes. Treatment depends on multiple factors including initial stage and grade of cancer, age at diagnosis, menopausal status at diagnosis, need for other hormonal treatments such as zoladex, the use of other treatments such as targeted therapy or immunotherapy, and comorbidities.

The end date of treatment should be clearly noted on letters from the Breast Cancer Unit and/or Medical Oncology if the patient is under their care.

If there are queries from Primary Care regarding a patient’s treatment, including if the end date is not obvious, then these queries are best directed by email to the most recent clinician involved with the patient’s care, as indicated on the most recent clinical letter. This may be a Consultant Breast Surgeon, Clinical Nurse Specialist for Breast Cancer, or Medical Oncologist.

Bone Health in Breast Cancer

Assessing Bone Health in patients newly diagnosed with Breast Cancer is important. Please see the BONE HEALTH IN BREAST CANCER ALGORITHM NOV 25 for advice on how this should be done, taking into account menopausal status, treatment in place and the patient’s individual 10-year fracture risk.

The algorithm gives guidance on when DEXA should be carried out, what action should be taken based on the DEXA results and when future assessments including repeat DEXA scanning if indicated should be carried out.

Following this algorithm will largely be carried out by the Secondary Care Breast Team, until the patient is discharged from the service. GPs may find it helpful to know what the Breast Unit processes are if issues relating to Bone Health in Breast Cancer are raised by patients, and they may find it useful to know when they are being asked to take over prescribing off bisphosphonates or have treatment holidays from bisphosphonates, why this is being advised. 

For patients who have been discharged from the Breast Unit but who need assessed for DEXA referral GPs can order this in the usual way (see guidance on the RefHelp DEXA page).

The 10 year fracture tools referred to are QFracture and FRAX.

Breast Cancer and Managing Menopausal Symptoms

Managing Menopausal symptoms in Breast Cancer patients can be complex, as HRT is generally avoided after (any) breast cancer. (In some instances, topical oestrogen may be advised by EBU, for significant symptoms, and when all other treatments have been reviewed.)

Advice on the Menopause pages on RefHelp can provide guidance on other advice regarding management of Menopausal symptoms including lifestyle advice and non-HRT prescriptions. Please do remember however that that fluoxetine and paroxetine should not be used in combination with tamoxifen.

If patients are having significant menopausal symptoms and wish to discuss their current treatment, then please seek specialist advice from Breast Cancer clinic (if the patient is still under their care) or from the Menopause clinic.

TF, EC, LP & JB FEB 26