OBJECTIVES: Breast cancer is the most common cancer in women in England and the second most common cause of cancer death. In 2011, there were >40,000 new breast cancer cases and >10,000 deaths, with delay to diagnosis thought to be an attributing factor. Our aim was to map out the breast cancer diagnostic pathways for women in England, quantify the number of women proceeding through each step of the pathway, and compare it to the pathway in France and Germany. METHODS: We performed literature searches for peer-reviewed papers and other published data from England, and conducted semi-structured interviews with cancer experts to understand the breast cancer diagnostic process. A patient pathway framework for diagnosis was modelled in Microsoft Excel and patient flow was quantified with published data and our own calculations where there were missing data. We validated the model with data from France and Germany. RESULTS: England’s well-organised National Health Service Breast Screening Programme (NHSBSP) identifies women with early stage breast cancer to manage them promptly. Whilst NHSBSP coverage is 75% of invited women, only 40% of all malignancies are identified through screening, with the remaining cases from symptomatic referrals to breast services. We estimated that ~230,000 women present in general practice with breast symptoms annually and are referred to breast services, an estimated 46,000 symptomatic women have biopsies, yielding 24,528 malignant cases. The ratio of women attending breast services, having a biopsy, and having a malignancy differ between screened and symptomatic women. The diagnostic pathway is similar in France and Germany, although the proportion identified through screening differs. CONCLUSIONS: Data on the full breast cancer diagnostic pathway are sparse, especially for women with symptoms. Our complete diagnostic pathway gives a full understanding about the diagnostic process, tests conducted, and quantifies the burden on healthcare services.