Case 1 – Breast Mass

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.


  • 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


  • 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)


  • 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