You are seeing Mrs. Thompson, a 56 year old woman, in your outpatient clinic today. She is worried about a left breast mass, and would like your reassurance that it isn’t cancer. Take a focused history of her complaint and perform a focused physical exam.
History
- Onset of awareness of mass
- Size of the mass and change in size
- How mass was identified
- Mastalgia
- Associated discharge, including pus and blood (none)
- Size/tenderness association with menstrual cycle
- Nipple changes
- Skin changes (on affected breast)
- Systemic symptoms – weight loss, low energy, anorexia
- Associated shortness of breath or chest pain
- Changes in personality – suggestive of brain metastases
- Bone pain – suggestive of bone metastases
- Inquires about date of menopause
- Pregnancy history
- Breastfeeding history
- History of chest radiation
- Age of menarche
- Alcohol history
- Smoking history (quantity in pack-years)
- Past and current use of hormone replacement and oral contraceptive pills
- Family history of breast, ovarian, or colon cancer
- Past history of breast masses
- Past mammography results
- Addresses patient’s concerns regarding the mass
Physical Examination
Inspection
- Drapes patient appropriately
- Inspects breast skin for discoloration, retraction, peau d’orange, or bruising
- Comments on presence of asymmetry
- Examines nipples, commenting on absence of discharge, irregularities, or retraction
- Examines areolas (no abnormalities)
Palpation
- Uses radial or strip method to palpate both breasts,
- Comments on texture, size, firmness, and mobility of any palpated masses
- Palpates axillary nodes bilaterally
- Palpates infraclavicular and supraclavicular nodes
Case 1 – Breast Mass