Breast Lump

Question 1

Initial Inquiry

Answer 1

SOCRATES

Question 2

Associated breast symptoms

Answer 2

Nipple discharge or bleeding: associated with infection (e.g. mastitis and breast cancer).
Nipple inversion: recent onset nipple inversion is typically associated with breast cancer.
Erythema: associated with breast abscess, mastitis and underlying breast cancer.
Ulceration: typically associated with breast cancer.
Dimpling (peau d’orange): associated with underlying breast cancer.
Fever: may indicate underlying infection (e.g. breast abscess).
Weight loss: may indicate underlying breast cancer.
Malaise: associated with breast abscess and breast cancer.
Lymphadenopathy: typically involving the lymph nodes of the axilla and neck (e.g. breast cancer, breast abscess).
Bone pain: consider the possibility of metastatic breast cancer.

Question 3

Systemic review

Answer 3

FWARJTL
Then think of metastases;
Systemic: fevers (e.g. breast abscess)
Respiratory: shortness of breath (e.g. lung metastases)
Gastrointestinal: abdominal pain, nausea and vomiting (e.g. bowel obstruction)
Neurological: confusion (e.g. brain metastases)
Musculoskeletal: back pain (e.g. spinal metastases)

Question 4

Background

Answer 4

PMH (radiotherapy to chest) 
DH
FH
SH
ICE

Question 5

Risk factor questions

Answer 5

Early menarche
Late menopause
Children 
Breastfeeding 
COCP/HRT

Question 6

Impact

Answer 6

ICE

Feelings and impact on life