Approach to Palpable Breast Mass

Accompanied by Breast Exam

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In addition to the ‣)

Write down the reason of asking and how it affects DDx

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• Breast Hx – focus on differentiating breast Ca from other causes of ‘lump(s)’

Key DDx

• Breast cancer (most r/o)
• Benign papilloma (most likely)
• Ductal dilation

Key Points in HPI

• P (position): Is it unilateral or bilateral;
• T (temporal changes):
  • How and when it was found?
  • How long has the lump been there?
  • Any change, growth or progression?
  • Constant or intermittent?
• UV:
  • has this happened before?
  • Any evaluation or investigations to date?

Associated Symptom

• Assoc. Symptom:

  • Any change with menses in premenopausal women?

  • *in a patient with a tender, red, swollen breast, ask about fever and other systemic symptoms.

    • Mastitis
      • ‣
      • IVDU injecting at the breast
    • Inflammatory BC
      • Clinical diagnosis: a whole breast
      • +/- mass →
        • Dx: punch Biopsy
      • Don’t usually have fever, may or may not have pain
      • Most aggressive sub-type

  • Galactorrhea

    • Is it spontaneous?
      • “How do you notice it?”
      • “Do you squash your nipple?”
    • Unilateral vs. bilateral

    PEARL: Only truly spontaneous, unilateral and uniductal bloody, serosanguinous or serous/clear (colour doesn’t matter) nipple discharge is of concern.

Additional Screening Questions

Key PMHx

• Past Radiation
  • Hodgkin Lymphoma (HL) → Radiation Therapy (risk starts developing 10 yr after radiation)
• Past breast history
  • High-risk non-malignant breast pathology
    • e.g. atypical hyperplasia (a risk factor for the development of breast cancer).