History

A diagnosis of carcinoma is suggested by a strong family history, nulliparous state, early menarche, late menopause and history of cystic hyperplasia. The patient may have found a breast lump (carcinoma is painless in 85% of cases) or may have noticed nipple retraction, skin dimpling, axillary swelling. Jaundice may have occurred due to liver secondaries or porta hepatis node involvement. Bone pain may be due to secondary deposits and pathological fractures. Breathlessness may be due to lung secondaries or a pleural effusion. Personality change, fits, headaches suggest cerebral metastases. A patient who presents in pregnancy or lactation may have mastitis, abscess or galactocele. A history of trauma suggests fat necrosis. A patient in the fifth decade with retroareolar pain, nipple retraction and a thick, creamy nipple discharge suggests duct ectasia. The patient presenting between the ages of 15 and 25 years with a non-tender swelling suggests fibroadenoma. A patient with a history of painful breasts may have one of the conditions described under breast pain (p. 56). Enquiries should be made of a past history of TB, as rarely a tuberculous abscess may form within the breast or erode through the chest wall from the lung.