Breast Cancer Initial Assessment

Clinical Presentation

Patients present with a breast nodule, mass, or abscess. The most common symptom of breast cancer is a new lump or mass in the breast. A painless, hard, irregular mass is more likely to be cancerous; however, it can also be tender, soft, rounded, or painful.  

Other signs and symptoms include breast pain or nipple pain (very rare), nipple discharge, nipple retraction, and the presence of breast skin changes (eg peau d’ orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess). 

History

During medical history taking, ask for symptoms such as breast pain or the presence of a new mass in the breast. Assess risk factors for breast cancer such as history of breast cancer, chest irradiation, and strong family history.  

Physical Examination

A complete breast examination includes inspection and palpation of the breasts. It should be done in upright and supine positions to determine subtle shape or contour changes in the breasts. Determine the presence of a palpable lump or mass and its characteristics (eg location, size, texture, mobility, presence of asymmetric thickening or nodularity, retraction, nipple discharge, and skin changes). Assess for axillary, supraclavicular, and internal mammary lymph nodes (LNs) and other organs for metastatic disease.  

In patients with nipple discharge without a palpable mass, evaluate the character of the discharge for other causes.  

In asymptomatic patients with a negative physical examination, perform risk assessment followed by appropriate screening and follow-up as recommended.