History And Examination Of The Breast

(1) Benign Breast Disease:

• Most women who present with breast pain, nipple discharge or breast masses are primarily concerned about the possibility of breast cancer
• A careful, through history and physical examination are essential to evaluate these condition

(2) Breast Cancer:

• Breast cancer is the commonest cancer among women
• one in every 12 women develop breast cancer at some time in her life
• Moreover, breast cancer is the most common single cause of death in women at the age of 35-54 years

History:

• It should include:

1. Age of the patient, age at menarche; parity, including age at first delivery; occurence of breastfeeding after each delivery and for how long
2. Method of birth control and duration of use
3. personal and family history of cancer, particularly breast, ovarian and colon
4. the types and duration of medications and procedures used in women with a history of infertility
5. The use of postmenopausal hormone replacement therapy (HRT)

Physical Examination:

• Particular attention should be paid to:

1. Palpable breast lumps
2. Skin changes (such as dimpling)
3. Nipple direction, which may be altered due to retraction from an underlying carcinoma
4. women with breast implants should be reffered to a breast surgeon

• Women with benign breast conditions generally present with one of three signs or symptoms: breast, nipple discharge or breast mass.

(1) Breast Pain (Mastalgia or Mastodynia)

• Of the three clinical findings, breast pain is the least likely to be associated with breast cancer
• Types of breast pain:

1. Cyclic mastalgia - Breast pain varies with the menstrual cycle
2. Non cyclic mastalgia - This breast pain does not vary with the menstrual cycle
3. Breast pain associated with cancer - This type of breast pain is uncommon and it is more likely to be unilateral, localized, unremitting and constant

(2) Nipple Discharge

• Approxiamtely 3 to 10% of breast complaints involve nipple discharge
• Types of discharge:

Benign nipple discharge	Malignancy nipple discharge
- It is generally bilateral - It is more likely to be milky - It may be yellow or green in color - It is apparent at several ducts and can be elicited with breast manipulation	- It is more likely to be unilateral - It is usualy pink, bloody and non milky - It is frequently associated with breast mass

• Ductal papilloma is characterized by bloodstained secretion from the nipple

• Evaluation:

1. Hormonal essay: prolactin and Thyroid-stimulating hormone (TSH) levels should be evaluated
2. CT scan and MRI

(3) Breast Mass

• These may be:

Benign breast masses	Malignancy breast masses
- It is more likely to be soft or cystic - It have regular borders - It is freely mobile	- It is asymptomatic early in the course of breast

• Types of benign breast masses:

1. Fibrocystic disease or fibrocystic change
2. Cyst
3. Fibroadenoma
4. Sclerosing adenitis
5. Fat necrosis
6. Duct ectasia