Breast Exam/Breast Lumps

Question 1

Describe steps of breast examination

Answer 1

Examine 
1. with arms by her side
2. with arms raised above head
3. pressing on hips and leaning forward
(contracting pectoral muscles).

Pay particular attention to:
• breast contours — skin changes such as erythema,
dimpling or puckering, peau d’orange, visible lumps

• nipples — height, any inversion, erythema, eczema,
nodules, ulcers.

> > Palpation with the fingers; patient seated or standing:
• palpate supraclavicular and axillary fossae
• palpate breasts, particularly upper quadrants and
bimanual examination

> > patient lying at with ipsilateral arm behind her head:
• palpate all quadrants and axillary tail and around and
behind nipple

Details of any lump — including size, shape, consistency, mobility, tenderness, xation and exact position - should be recorded.

Question 2

Breast Cancer:
Risk factors

(ref: breast-cancer-risk-factors-a-review-of-the-evidence)

Answer 2

1/ RR>4
Female
Increasing Age
Family history (BRCA1, BRCA2)
Breast conditions: Cancers in situ (lobular or ductal carcinoma insitu), atypical hyperplasia
Radiation for hodgkin's before 30 yrs 

RR 2-3.99
2 or > first dgree relatives with breastCa

RR 1.25-1.99
x1 first degree relative or multiple 2nd degree relatives 
Combined OCP 
Early age at menarche (<12 yrs)
Older age at menopause (>55yrs)
3 or > standard drinks/day 
Exposure to ionising radiation before 20

Question 3

What tool can be used to assess the familial risk factor for an individual?

Answer 3

Familial Risk Assessment FRA-BOC Tool

Question 4

Examining a lump, what to look for?

Answer 4

size 
shape 
contour 
colour 
Soft, rubbery or hard 
Tenderness
Tethering to skin 
Transillumination 
Other lumps 
(KFP online question Dr Raja)

Question 5

Ddx for breast lump

Answer 5

Benging

• fibroadenoma
• fibrocystic change
• glandular parenchyma (cyst)
• phyllodes tumour
• Abcess

Malignant

• breast cancer
• malignant

(RACGP Check 2011)

Question 6

What is the triple test?

Answer 6

Breast history and examination 
Imaging 
- mammography
- u/s
Biopsy
- core 
- FNA 
(RACGP Check 2011)

Question 7

Fibroadenomas increase the risk of breast cancer T or F

Mastitis or breast abcess, continue breastfeeding T or F

Answer 7

False:
Ref: https://www.thewomens.org.au/health-information/breast-health/fibroadenomas/

True
(RACGP Check 2011)

Question 8

Features of nipple discharge
1/ physiological
2/ Pathological

Answer 8

1/ milky, yellow greenish
discharge only when expressed
discharge from multiple ducts

2/ serous or bloody
spontaneous discharge
discharge from single duct

(RACGP Check 2011)

Question 9

Causes of Nipple Discharge

Answer 9

Physiological

Hormonal

• lactation
• prolactinomas
• drugs that increase prolactin (e.g. antipsychotics, OCP, HRT, SSRI’s, metoclopramide)

Breast Cancer

Duct Papilloma (rare associated with breast ca)

Paget’s Disease of the nipple
(RACGP Check 2011)

Question 10

DDx of mastitis

Answer 10

mastitis - secondary to lactation

periductal mastitis
- inflammatory condition, common in smokers

granulomatous mastitis
- rare cause of inflammation of breast

Inflammatory Breast Cancer

lactating adenoma
(RACGP Check 2011)

Question 11

DDx of mastalgia

Answer 11

Mastalgia

• cyclical
• non-cyclical

Non breast pain
- orginating from chest structures

Local benign breast condition
- fibrocystic change

Breast Ca
- rarely presents with breast pain alone
(RACGP Check 2011)

Question 12

1/ What does ER+, PR+ve mean
2/ prognosis for above?
3/ HER 2 +ve - what does this mean?
4/ Prognosis

Answer 12

1/ receptors for estrogen and progesterone +ve
2/ Good prognosis, breast Ca relies on E+P for growth
–> Tamoxifen to block these receptors
3/Human epidermal growth factor receptor 2 is a receptor for growth factors on the surface of the cells
4/ less common, poor prognosis