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Malignant Neoplasm of the Breast B019

Last amended 
22 September 2023
Current RMA Instruments

Reasonable Hypothesis SOP

84 of 2023 as amended

Balance of Probabilities SOP

85 of 2023 as amended

Changes from previous Instruments

SOP Bulletin 238

ICD Coding
  • ICD-10-AM Codes: C50, D05
Brief description

This SOP covers primary malignant neoplasms of breast epithelial tissue. Note that this SOP applies to males as well as females.

Confirming the diagnosis

Diagnosis requires histology from a biopsy or surgical specimen.

The appropriate medical specialist is an oncologist or breast surgeon.

Additional diagnoses covered by SOP
  • Breast adenocarcinoma
  • Breast carcinoma in situ – ductal, intraductal or lobular
  • Infiltrating ductal breast carcinoma
  • Metastatic breast cancer from a breast primary
  • Other histological breast carcinoma types – invasive lobular; ductal/lobular; mucinous; tubular; medullary; or papillary
  • Paget’s disease of the breast. This is a breast carcinoma of the nipple of the breast
Conditions excluded from SOP
  • Carcinoid tumour of the breast #
  • Hodgkin's lymphoma of the breast *
  • Malignant neoplasm of the skin overlying the breast
    • melanoma *
    • non-melanitic *
  • non-Hodgkin lymphoma of the breast *
  • Secondary metastasis to the breast (code to primary site)
  • Soft tissue sarcoma of the breast *

* another SOP applies

#  non-SOP condition

Clinical onset

Clinical onset will generally be when a breast lump (subsequently confirmed to be a breast cancer) is first found or when a screening mammogram first shows evidence of the condition.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  The disease has a very variable course and prognosis.  It is particularly amenable to treatment if found early.  A delay in appropriate treatment could result in worsening of the condition.  Establishing whether worsening beyond the normal course of the disease has occurred will generally require expert medical opinion.