Rapid-Fire Presentations

RF21 Assessment of male patients in triple assessment breast clinics after introduction of updated ABS guidelines – a quality improvement project

Abstract

Introduction Gynecomastia represents the most common reason for male attendances to breast clinics in the UK. This study aims to evaluate concordance of clinical practice to national guidelines at a tertiary breast unit.

Methods 2021 ABS Gynaecomastia guideline was utilised. Two cycles were conducted: Jun-Aug 2022, and Feb-May 2023. An educational intervention including development of a poster for clinical areas was implemented, with cycle 2 evaluating for improvements.

Results Cycle 1 and 2 had 62 and 97 patients respectively. Both cycles showed similar documentation rates of P stage (1-65%,2-70%), medication history (1-71%,2-75%), alcohol history (1-27%,2-27%), recreational drug use (1-24%,2-34%), steroid use (1-21%,2-32%) and family history (1-66%,2-73%). In both cycles the majority underwent imaging (1-94%,2-97%). Gynaecomastia was the most common diagnosis (1-68%,2-64%), with 1 cancer diagnosis across both cohorts. 6% of cycle 2 vs 24% of cycle 1 underwent further secondary care investigations. More discharges from clinics were observed in cycle 2 (2-90%,1-63%). 17% of cycle 1 discharge letters gave variable advice for further GP investigations, whilst 33% of cycle 2 letters gave explicit advice in accordance with guidelines.

Conclusion Post-intervention there was reduction in intra-departmental variability in investigation of gynaecomastia. Imaging rates remained high, with likely multi-factorial causality. Documentation rates did not significantly improve, which introduction of a proforma may address.

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