WEEK 4: BREAST Flashcards
THE HEALTH HISTORY QUESTIONS for breast
Do you examine your breasts? How often? When?
Are there any changes?
The day after the last day of menstrual cycle is ideal
This is no longer recommended by experts as routine, however ACS DOES advise women should be familiar w/what their breasts normally look and feel like (there is no alternative given for how this should be accomplished)
Do you have discomfort, pain, or lumps?
Do you have discharge from the nipple?
When does it occur? (regularly vs irregularly)
PMH and FH for breast
Previous breast conditions
History of radiation
Trauma to chest or breast
Breast implants
Genetic/hepatic/hormonal disorders
Testicular cancer
Medications: HRT (hormone replacement treatment), BCP (birth contorl pills), Testosterone
Early menarche/late menopause (higher estrogen since starter earlier)
Pregnancy
Childbirth
Breastfeeding
Family history: Breast cancer history, premalignant lesions of the breast, ovarian/peritoneal cancer, pancreatic cancer, testicular/high-grade prostate cancers, known BRCA 1 and BRCA 2 genetic mutations
Social history: Smoking and alcohol
Preventive care considerations: Healthy lifestyle behaviors
Menstrual cycle, menopause
MALE BREAST CA assessment questions
Gynecomastia/breast tissue growth, breast pain, lumps:
Ask about family hx (same questions that we ask of female patients)
Medication review: testosterone, estrogen or spironolactone/aldactone, supplements
HPI questions: same as female other than menstruation (unless sex assigned at birth was female, then don’t forget to ask about menstruation)
Exam: perform a thorough CBE and axillary lymph node exam
Male Risk factors for breast CA
Risk factors: increasing age, radiation exposure, BRCA gene mutations, Klinefelter syndrome, testicular disorders, alcohol use, liver disease, diabetes, and obesity
Usually present w/more advanced stage disease
INSPECTION for breast
Inspect the breasts with the patient in sitting position and disrobed to the waist
Improvise as needed (pull back gown to one side)
Consider cultural issues
Inspect both breasts
Color: erythema?
Symmetry: shape, size,
nipples (inversion, cracking, d/c, lesion)
Retraction of breast
Discharge, lesions
Dimpling: peau d’orange
INSPECT AXILLAE & PALPATE AXILLARY LYMPH NODES
Inspect:
Rash, lesion? Ingrown hair?
Acanthosis Nigricans (darkened area) - indicate PCOS, diabetes, prediabetes
Palpate: Use a three finger, circular motion: gloved or w/gown
Axillary lymph nodes
PALPATE breast technique
examine the entire breast, cover all tissue in a systematic approach
Vertical strips is the best method: DON’T FORGET THE TAIL OF SPENCE
Overlap somewhat
Don’t miss tissue
Use first 3 fingers, small circles- light, medium, then deep pressure
Palpation
Place patient in a supine position w/arm above their head
Prefer w/out gloves
Ask about tenderness
If you find abnormality, fibrocystic (‘lumpy’) tissue: compare for symmetry
What doe the exam entail for Palpation
Examine breast tissue for: Consistency of tissues Tenderness Warmth Mass/Nodules Location: the “Clock” of the breast, location in relation to the areola (distance from), quadrant Size: approximate Shape: round, irregular, oval Consistency: firm, rubbery, smooth, rough Tenderness: tender vs nontender Mobility: mobile, immobile/fixed
