Page 413 - Medicine and Surgery

P1: KTX
BLUK007-10 BLUK007-Kendall May 12, 2005 20:3 Char Count= 0

Breast disorders 10

Clinical, 409 Infections of the breast, 415 Breast cancer screening, 418
Benign disorders of the breast, 412 Breast cancer, 415

Clinical bined approach gives a diagnostic accuracy exceeding
99%.
Symptoms
Clinical features
Breast lumps The history should include when and how the lump was
discovered, whether it has grown and whether there have
Breast tissue is normally lumpy and women commonly been any previous lumps. Other important aspects in-
have premenstrual breast changes including generalised clude a family history of breast cancer (including the
tenderness, lumpiness and nodularity, which recedes af- numberoffirst-andsecond-degreerelativesaffectedand
termenstruation. Nodularity may be generalised or lo- their age at diagnosis), history of oestrogen usage, in-
calised and it may be difficult to differentiate a localised cludingthecombinedoralcontraceptivepillorhormone
area of nodularity from a discrete breast lump. It should replacement therapy, pregnancy history and history of
however be noted that particularly in younger women, breast feeding. A menstrual history including the date of
breast cancer may present as an area of localised nodu- last menstrual period should also be documented.
larity. Further assessment is required for any new dis- Inspection of the breasts starts with the woman sitting
crete lump, a new lump within pre-existing nodularity upright with her arms to the side and then raised above
or asymmetrical nodularity that persists after menstru- her head. The symmetry of the breasts and evidence of
ation. any skin changes (see Table 10.1) should be noted. The
Many women develop one or more breast lumps dur- breasts should be palpated (normal breast first) exam-
ing their lifetime. Whilst the finding of a lump is very ining each quadrant in turn. Both axillae should be pal-
distressing, the majority are due to benign breast dis- pated for lymph nodes.
orders (see page 412) and only a minority are due to Afirm discrete lump with no associated skin features
carcinoma of the breast. A lump larger than 1 cm in size in a younger woman is most likely to be a fibroade-
is usually palpable, although some are missed until they noma.
are much larger. Acystmaybesoft,firmortenseandhard.Itisgenerally
The clinical approach to breast lump assessment spherical.
uses a triple approach combining clinical examination, Signssuggestive of a malignant lump include hard
imaging and fine needle aspiration cytology (FNAC) texture, poorly defined edges and fixation to skin
and/or needle core biopsy (see page 412). This com- or underlying tissues. There may be associated

409