Breast disease- History + Exam Flashcards
Presenting complaint
Lump Nipple Discharge Pain Hormonal history Past breast history RFs for breast problems General health + other comorbidities
Lump
Size Shape When appeared How you found it Change over time
Nipple discharge
Uni or bilateral Single or multi duct Spontaneous or simulation Colour Pregnancy or breastfeeding?
Pain
Onset Site Severity Relieving or exacerbating factors Relationship of symptoms to menstrual cycle Radiation
Hormonal history
Puberty Menstruation history--> regular, heavy, painful, PMS Contraceptive history Pregnancy history Breastfeeding history Menopause
Past breast history
Previous breast cancer, visits or breast clinic or breast surgery
RFs for breast problems
FH
Alcohol
Weight
Smoking
General health + other comorbidities
Medications –> especially hormones
Other medical conditions
RF History- FH
Ask about which relatives (both maternal + paternal)
–> 1st degree= mother, sister, daughter
–> 2nd degree= grandmother, aunt, niece
What age were they diagnosed
What their diagnosis was
Having extensive FH with cancer at early age increases risk of genetic mutations that predispose to BC
Genetic mutations
BRCA1, BRCA2- tumour suppressor gene involved in repair of damaged DNA
Lifetime risk of BC for BRCA1= 40-65%
Lifetime risk of BC for BRCA2= 40%
TP53- tumour suppressor gene involved in cell cycle regulation, apoptosis and DNA repair
RF history- Age
Risk increases with age
RF history- Pregnancy
Never having child or having child after 30 increases risk
RF history- BF history
Protective
RF history- age of menarche
Earlier menarche increases risk
RF history- age of menopause
Late menopause increases risk
RF history- HRT
Increases risk
RF history- Radiation history
Includes any chest x rays or nuclear medicine scans that may have been performed
Even small doses can increase risk
RF history- Weight history
being overweight, especially after menopause, increases BC risk
RF history- Alcohol
Increases risk of BC in dose dependent manner
Breast Exam- Observation
Look at breasts while patient is standing with arms by side, raised above head + pressed against hips
Assess symmetry
Look at contours
Observe colour/texture of skin
look at nipples + assess symmetry, if inverted, any discharge + any abnormalities
Breast exam- palpation
Patient lie flat with arm raised + on shoulder + forehead
Use finger rotary movement, start in axilla, move to mid-axillary line + then back up a line more medial to this and then down line more medial to this + so on
Examine nipple- lumps
Feeling for lumps- continue all way to sternum
Lumps- size, shape, constituency, tenderness, mobility etc
Breast exam- axillary LNs
Relax arm + hold at elbow with one hand
With other hand feel for central LNs against chest wall + in apex of axilla
Any lumps described same way as breast lumps
If central nodes found, also feel for pectoral, posterior axillary + lateral
Examine supra and infraclavicular fossa
Malignant breast masses
Hard Painless (90%) Irregular margins Fixation to skin or chest wall Skin dimpling may occur Discharge- bloody, unilateral Nipple retraction may be present
Benign breast masses
Consistency- firm or rubbery Often painful Regular or smooth margins Mobile and not fixed Skin dimpling unlikely Discharge- no blood, bilateral, green or yellow No nipple retraction