Breast Lump History

Question 1

What should you ask for presenting complaint of a breast lump history?

Answer 1

Whats brought you in today?

Ok, so tell me more about that/can you explain what the pain was like?

Question 2

What questions should you ask about the lump in HPC?

Answer 2

Size – Has it changed? / Over what duration?

Onset – When did they first notice the lump?

Is the lump painful? – ask SOCRATES

Is the lump’s size or discomfort related to the menstrual cycle in any way?

Question 3

What are the local associated symptoms?

Answer 3

Local associated symptoms-
Nipple discharge or bleeding?
Nipple inversion? – Is this new or has it always been the case?
Skin changes overlying the lump or elsewhere on the breast?
- Eczema
- Dimpling
- Ulceration

Systemic symptoms:
Weight loss
Fever
Lethargy
Pain elsewhere – e.g. spine / axilla / abdomen
Gland swelling – lymphadenopathy

Has the patient ever experienced similar symptoms in the past?

If any of these symptoms are present then get further details:
Onset, duration, severity, course, intermittent/continuous, precipitating, relieving factors, previous episodes?

ICE!! thoughts regarding symptoms? any worries? gain understanding of what the patient is hoping to achieve in this consultation

Summarise their PC for your understanding, their correction & expansions of certain aspects. ask if youve overlooked anything & continue to periodically summarise throughout the Hx: signpost now talked about breast lump and concerns, woudl like to discuss PMH and meds

Question 4

What are the PMH and Dx questions to ask in a breast lump history?

Answer 4

relevant obs/gynae hx

• Age at menarche/menopause
• parity (viable age)
• age at first preg
• did they breastfeed
• on HRT or ORC?

relevant PMH:

• recent breast trauma
• previous breast disease
• any other previous malignancies?
• other significant medical problems?

Surgical Hx or breast or other surgery?

Question 5

What should be asked in a Dhx, Fhx or Shx?

Answer 5

Dhx:
Prescribed meds? OCP? HRT?
over the counter, reg meds, herbal remedies, allergies?

FHx - of breast disease? consider BRCA mutations

SHx - smoking, alcohol, rec drugs
living situation, accommodation? who lives with the patient? any carer input?
ADLs?
Occupation? coping? expected duties

Question 6

What should be asked in a systems review?

Answer 6

Systemic enquiry involves performing a brief screen for symptoms in other body systems.

This may pick up on symptoms the patient failed to mention in the presenting complaint.

Some of these symptoms may be relevant to the diagnosis (e.g. back pain in metastatic breast cancer).

Choosing which symptoms to ask about depends on the presenting complaint and your level of experience.

Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea / Peripheral oedema

Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain

GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal pain / Bowel habit

CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness / Confusion

Musculoskeletal – Bone and joint pain / Muscular pain

Dermatology – Rashes / Skin breaks / Ulcers / Lesions