For physicians: Frequently asked questions

Any individual with an abnormality on a mammogram, breast ultrasound, or a clinical finding that is highly suspicious for malignancy may be referred to the breast RDU. (e.g. BIRADS 4 or 5 on mammogram, suspicious breast lump, clinical findings of inflammatory breast cancer, etc.)

Most patients referred to the breast RDU will receive two appointments. The first appointment will include a nursing assessment, mammogram, ultrasound, possible core biopsy, and possible fine needle aspirate biopsy. Patients will return the next day to see a Sunnybrook breast physician to receive their diagnosis. The breast RDU nurse navigator and physician will ensure concordance between the imaging findings and final pathology.

Please complete the breast RDU referral form and fax to the Odette Cancer Centre new patient booking office (fax: 416-480-6179).

Please tell your patient that the RDU nurse navigator will be in contact with them to give them more information about their appointment and what to expect. During that call, they will discuss:

• If your patient’s initial imaging is not from Sunnybrook or it is not available on a local or on the regional imaging database, they will be asked to contact the place where the imaging was done to pick up a CD that has their imaging on it.
• They will set up an appointment for further imaging and biopsy.
• They will provide instructions for preparation for the appointment.

Prior imaging review:

• Before an RDU appointment, a radiologist at Sunnybrook will review the imaging to ensure the findings meet the eligibility criteria. If the imaging findings are not concerning for malignancy (cancer), the patient may be seen outside of the RDU, as the RDU appointments are reserved for findings that are suspicious for malignancy and likely to require biopsy.

Please remind your patient:

• Tell the nurse navigator about any blood thinners they take (eg. Advil, Aspirin, Naproxen, Warfarin, Plavix or Apixaban). The nurse navigator will give instructions about when to stop taking these medications.
• Tell the nurse navigator if they have any allergies to local anesthetic or latex.

• They can eat before the appointment. A healthy breakfast is encouraged to help prevent you from feeling lightheaded during the procedures.
• They are welcome to contact the RDU nurse with any concerns.

If you, as the referring physician, prefer to deliver the diagnosis and arrange appropriate management, please indicate this on the referral form. It will be your responsibility to ensure the patient is seen in follow-up and to ensure concordance between imaging findings and pathological diagnosis. Otherwise, all patients evaluated in the breast RDU will be given a follow up appointment with a breast physician within a few days for appropriate management, and you will receive a letter from the breast physician summarizing all findings and management recommendations.

Patients who do not have breast cancer, but are felt to be at high risk of developing breast cancer (e.g. due to familial history) will be referred to the Odette Cancer Centre's high risk clinic for further assessment. The high risk clinic offers women genetic counseling and possible BRCA testing as well as advice regarding screening and breast cancer prevention strategies.

Please feel free to contact the Sunnybrook breast RDU nurse navigator at 416-480-6100 ext. 685047 during the hours of 7:30 a.m. - 3:30 p.m. Monday to Friday.