Breast problems

• Breast problems must be carefully assessed to find cause
• Use the 'triple test' approach
• History and clinical examination
• Imaging — breast ultrasound and mammogram
• Biopsy — tissue diagnosis
• Most women with breast problems do not have breast cancer
• Women of any age may present with breast problems
• Pregnancy and breastfeeding can cause lumps in breast

Ask

• Symptoms
  
• Lump OR change in shape or size of breast
• Change to nipple — crusting, ulcer, redness, inversion
• Nipple discharge
• Change in skin — redness, dimpling, puckering
• Unusual persistent pain, especially if only in 1 breast
• When first noted
• Constant or changing
• Related to periods
• Medicines especially contraceptive pills, MRT
• Menopause — when periods stopped
• Pregnant
• Breastfeeding
• Number of children and breastfeeding history
• Previous breast problems and tests
• Family history of breast cancer or other cancer (eg ovary, endometrial)
• Smoking and alcohol intake

Check

• Ask woman to show you problem area/s
• Do breast examination
• Check lump/s
• Position
• Size, shape
• Consistency (hard or soft)
• Mobility, whether joined to skin or muscle
• Tenderness

Do

• Medical consult about any woman with breast problem
• If young woman with breast tenderness, lumps, thickening before period — check again after period to see if problem has gone. If problem still present — medical consult again

Follow-up

• Most women with breast problem need
• Diagnostic mammogram (breast x-ray) at hospital or radiology service (not BreastScreen Australia)
• AND breast ultrasound
• AND biopsy (tissue diagnosis) - may be done by radiologist at time of ultrasound or by surgeon
• On pathology request form
• Describe breast abnormality and position
• Request mammogram, ultrasound and biopsy
• Priority recall for medical consult after radiology appointment