Updating the Scottish referral guidelines for suspected cancer

Many symptoms of secondary breast cancer are very similar to other health conditions. For example, people may feel constantly tired, experience nausea, and unexplained weight loss. And symptoms can change depending on where in the body the cancer cells have spread to.

The average General Practitioner (GP) will also see very few people with secondary breast cancer during their career. This means it can be challenging for GPs to recognise when someone might have secondary breast cancer.

We know from our UK-wide 2019 survey that almost a quarter (23%) of secondary breast cancer patients had to see their GP 3 or more times before they were diagnosed. And 41% of patients who had spoken to a healthcare professional didn’t feel their secondary breast cancer symptoms were taken seriously.

That’s why we’ve been working to make sure that GPs in Scotland have the tools and resources to recognise when a patient might have secondary breast cancer as quickly as possible.

The Scottish Government’s Cancer Action Plan 2023-2026 committed to reviewing and updating the Scottish Referral Guidelines for Suspected Cancer. These guidelines help GPs identify patients who are likely to have cancer and whether they need referral to a specialist for tests.

The breast cancer guideline has previously only focused on the signs and symptoms of primary breast cancer. And the guidelines didn’t cover vague symptoms that can be linked to multiple cancers as well as other health conditions. This made it even harder for GPs to recognise the signs and symptoms of secondary breast cancer.

As members of the Scottish Cancer Coalition, Breast Cancer Now were asked to take part in reviewing the guidelines. We had the opportunity to respond to an initial survey and attend a peer review session to help shape the breast cancer guideline.

We also called for a new guideline in Scotland around non-specific (vague) symptoms, and we fed into the process, helping to create this guideline.

Through our influencing, we’ve helped update the Scottish Referral Guidelines to include more guidance on identifying secondary breast cancer:

• For the first time, the breast cancer guideline now includes information on secondary breast cancer, helping GPs to recognise the signs and symptoms. And instructions that a previous diagnosis of breast cancer is a risk factor for developing breast cancer again
• The new non-specific symptoms guideline includes a reminder for GPs that vague symptoms could be a sign of secondary cancer, so it’s important to check if the patient has had a previous cancer diagnosis, including of breast cancer

We hope these updates will help GPs recognise when patients might be at risk of secondary breast cancer, so that more people can be diagnosed as quickly as possible.

Now, we’ll be working to make sure that GPs across Scotland are aware of the changes made to the guidelines. Next time you visit your GP surgery, why not ask if they are aware of the updates or share our posts on your social media channels.

Last year, we also welcomed the launch of Gateway C in Scotland, a cancer education platform which provides online courses and webinars to help educate GPs on cancer detection. One of these courses is a breast cancer recurrence course, which we helped develop back in 2021.

We’re continuing to monitor how many GPs and other primary care health care professionals are completing the course. We’ll also be encouraging the Scottish Government and NHS Scotland to ensure GPs have the capacity and time to take this training as part of their professional development.