■ Breast pain or discomfort
■ Nipple discharge
Questions about a woman's breasts may be included in the history or deferred to the physical examination. Ask "Do you examine your breasts?" . . . "How often?" In menstruating women, inquire "When during your monthly cycle?" Ask if she has any lumps, pain, or discomfort in her breasts. Approximately 50% of women have palpable lumps or nodularity in their breasts. Premenstrual enlargement and tenderness are common.
Also ask about any discharge from the nipples and when it occurs. If it appears only after squeezing the nipple, it is considered physiologic. If the discharge is spontaneous and seen on the underwear or nightclothes without local stimulation, ask about its color, consistency, and quantity. Is it unilateral or bilateral?
Important Topics for Health Promotion and Counseling
■ Risk factors for breast cancer
■ Breast cancer screening
■ Breast self-examination (BSE)
Lumps may be physiologic or pathologic, ranging from cysts and fibroadenomas to breast cancer. See Table 8-1, Visible Signs of Breast Cancer (p. 314), and Table 8-2, Common Breast Masses, (p. 315).
A milky bilateral discharge, or galactorrhea, may reflect pregnancy or prolactin or other hormonal imbalance.
A nonmilky unilateral discharge suggests local breast disease.
Women may experience a wide range of changes in breast tissue and sensation, from cyclic swelling and nodularity to a distinct lump or mass. The examination of the breast provides a meaningful opportunity for the clinician and the woman patient to explore concerns important to women's health— what to do if a lump or mass is detected, risk factors for breast cancer, and screening measures such as breast self-examination, the clinical breast examination (CBE) by a skilled clinician, and mammography.
Breast masses show marked variation in etiology, from fibroadenomas and cysts seen in younger women, to abscess or mastitis, to primary breast cancer. All breast masses warrant careful evaluation. On initial assessment, the woman's age and physical characteristics of the mass provide clues to its origin, but definitive diagnostic measures should be pursued.
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