Every year, about 3% of women visit their GP with breast symptoms, and many of them are terrified of having cancer.
The most common breast symptoms are:
- Pain: usually means a benign condition, especially if pain is cyclical and is the only symptom
- Lump: 9 out of 10 lumps are benign, but you cannot assume that at presentation
- Nodularity: can be cyclical and is often benign, but may coexist with cancer.
History
- Ask ‘How long have you had the symptoms?’
- Enquire about other symptoms such as discharge, skin changes or any change in the nipple or breast shape.
- Find out if pain or nodularity is related to periods. Are periods regular? Is the woman on HRT or the contraceptive pill?
- Is she breast-feeding now? While it’s interesting to know about previous breast-feeding, age at menarche and alcohol intake, these will not aid your diagnosis.
- Family history is important. Apart from being a risk factor, a close family history can also explain a patient’s high anxiety.
Examination
- Look first for any contour abnormalities or asymmetry, bearing in mind that size discrepancy between right and left is usual.
- Check for skin changes such as eczema round the nipple (could be Paget’s disease of the nipple, a localised cancer) or a pitted surface like the skin of an orange (called peau d’orange, a sign of more advanced cancer).
- Check for inverted nipples or discharge from the nipple.
- Palpate both breasts quadrant by quadrant, including each axillary tail, with the flat of your hand.
- Check for regional lymph nodes, even though axillary examination can be misleading.
- You may need to examine other areas (e.g. the spine or the abdomen), depending on your patient’s symptoms.
Management
Clinical features (see Figure 28) help discriminate between benign and malignant disease. Even so, your patient needs referral if there is a lump. A well-defined mobile lump in a young woman is likely to be benign, but it needs to be confirmed by biopsy.
You should also refer if there is:
Blood-stained discharge
Recent nipple inversion
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
