History Taking for a breast lump
Differentials
Opening the consultation
Introduce yourself – name/role
Confirm patient details – name/DOB
Explain the need to take a history
Gain consent
Ensure the patient is comfortable
1. Age – Fibroadenoma usually occurs in females below 35 years of age. Fibroadenosis at any age
but most common in middle age. Intramammary breast abscess is most commonly seen in
young lactating women i.e. Mastitis of lactation. Ca breast in around 40 years.
2. Residence – Ca breast and Fibroadenosis most common in western world especially England and
Wales. Breast Ca is rare in Japan.
3. Social status – Ca breast, Fibroadenosis –seen mc in developed world. ?link between diets rich in
saturated fatty acids and breast carcinoma.
Ca breast and Fibroadenosis – nulliparous women, women who refuse to breast
feed. These diseases are less common in developing worlds when women are multiparous.
4. Lump – Mode of onset?
Duration and rate of growth? Long history and slow growth is probably benign disease
either Fibroadenosis/mammary dysplasia or fibroadenoma except for atrophic scirrhous
carcinoma.
Short history and fast growth ?Ca breast,
5. Auxiliary lump – Ca breast
6. ? Trauma – Hematoma? Fat necrosis?
7. Pain – Ca breast is painless. 5% of patients with a malignant mass present with pain.
Pain in acute mastitis – throbbing
Pain in mammary dysplasia/Fibroadenosis which is aggravated in menstruation (cyclical)
in the young women. Fibroadenosis in post-menopausal women - localized breast pain due to
periductal mastitis or referred pain from musculoskeletal disorders.
Back pain, hip pain, shoulder pain – in longstanding Ca breast and bony metastasis.
8. Discharge from nipple – Fresh blood/altered blood in ductal papilloma or carcinoma.
Pus – in mammary abscess
Milk - during lactation, galactocele, or from mammary fistula due to
chronic sub-areolar abscess.
Serous or greenish discharge in Fibroadenosis/mammary dysplasia and
mammary duct ectasia.
9. Nipple retraction – since puberty can be developmental
Recent retraction – Ca breast
10. Systemic symptoms
Fever – inflammatory conditions
Lethargy
Pain elsewhere – e.g. spine / axilla / abdomen
Gland swelling – lymphadenopathy
Loss of weight – Ca breast, TB of breast or chest wall TB leading to retromammary abscess
11. Past history – abscess recurrence is sometimes seen in congenital retraction of nipple. Tb of
breast can recur. Fibroadenosis/mammary dysplasia may give rise to symptoms of a good gap.
Ca breast can recur in contralateral breast.
12. Personal history – Fibroadenosis and Ca breast in unmarried nulliparous women.
Menstrual history so that correlation with pain can be assessed.
Lactation history
Suppurative mastitis occurs particularly in women during fort lactational
period.
13. Family history – Ca breast in mother, grandmother etc; 1 st degree relatives
The current USPSTF recommendations are as follows:
Women who have family members with breast, ovarian, tubal, or peritoneal cancer should be
screened to identify a family history that may be associated with an increased risk for mutations
in the breast cancer susceptibility genes BRCA1 or BRCA2
14. History of medication use – OCPs and Ca breast
