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Breast Disorders

Clinical evaluation of a breast mass should assess duration of the lesion, associated pain, relationship to the menstrual cycle or exogenous hormone use, and change in size since discovery. The presence of nipple discharge and its character (bloody or tea-colored, unilateral or bilateral, spontaneous or expressed) should

Menstrual history. The date of last menstrual period, age of menarche, age of menopause or surgical removal of the ovaries, regularity fibrocystic change, nipple discharge, cyst of the, fibroadenoma menstrual cycle, previous pregnancies, age at first pregnancy, and lactation history should

History of previous breast biopsies, breast cancer, or cyst aspiration should be investigated. Previous or current oral contraceptive and hor mone replacement therapy and dates and results of previous mammograms should be niple, fibrosistic

Family history should document breast cancer in relatives and the age at which family members were

Physical examination

The breasts should be inspected for asymmetry, nipple discharge, cyst, deformity, skin retraction, erythema, peau d'orange (indicating breast edema), and nipple retraction, discoloration, or


The breasts should be palpated while the patient is sitting and then supine with the ipsilateral arm extended. The entire breast should be palpated systematically.

The mass should be evaluated for size, shape, texture, tenderness, fixation to skin or chest wall. The location of the mass should be documented with a diagram in the patient's chart. The nipples should be expressed to determine whether discharge can be induced. Nipple discharge should be evaluated for single or multiple ducts, color, and any associated mass.

The axillae should be palpated for adenopathy, with an assessment of size of the lymph nodes, their number, and fixation. The supraclavicular and cervical nodes should


Screening mammography is performed in the asymptomatic patients and consists of two views. Patients are not examined by a mammographer. Screening mammography reduces mortality from breast cancer and should usually be initiated at

Diagnostic mammography is performed after a breast mass has been detected. Patients usually are examined by a mammographer, and films are interpreted immediately and additional views of the lesion are completed. Mammographic findings predictive of malignancy include spiculated masses with architectural distortion and microcalcifications. A normal mammography in the presence of a palpable mass does not exclude malignancy.

Ultrasonography is used as an adjunct to mammography to differentiate solid from cystic masses. It is the primary imaging