Breast History

Question 1

Presenting complaint

Answer 1

SOCRATES

Key symptoms

• nipple discharge/bleeding - infection/cancer?
• nipple inversion - if not normal, cancer
• erythema - abscess/mastitis, cancer?
• ulceration - cancer
• dimpling/peau d’orange - cancer?

Fever - infection?
Weight loss - cancer?
Malaise - infection/cancer
Axillary/neck lymphadenopathy - cancer, infection
Bone pain - breast cancer mets?

Question 2

Systemic enquiry

Answer 2

Systemic - fevers = infection?
Resp - SOB = lung mets?
GI = abdo pain, N+V = bowel obstruction?
Neuro - confused = brain mets?
MSK - back pain = spine mets?

Question 3

Past medical history

Drug history

Answer 3

Medical conditions?
-treatments?

Hospital admissions/surgeries/procedures
-mammography, biopsies, operations

Periods

• when did periods start
• regular/irregular?
• length of cycle
• currently breastfeedingf
• have they gone through menopause?
• use of HRTs, contraceptives

Past breast lumps?
Hx of breast cancer?
Multiple CXRs?

Question 4

Family history

Answer 4

Specifically breast, bowel, ovarian cancer?

-clarify ages

Question 5

Social history

Answer 5

General

• accommodation
• social network, who they live with
• ADLs?
• occupation

Smoking - RISK FACTOR
-pack years

Alcohol - RISK FACTOR
-try to calculate units

Rec drug use - IVDU RISK FACTOR for ABSCESSES