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396 PHYSICAL EXAMINATION

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UNIT 2

TABLE 12.1 continued>>

DEVELOPMENTAL STAGE

3 Adolescent stage (10–14 years). Nipple

is flush with breast shape. Breast and areola enlarge. Menses begin. Height spurt peaks.

4 Late adolescent stage (14–17 years).

Nipple and areola form a secondary mound over the breast. Height spurt ends.

5 Adult stage. Nipple protrudes; areola is

flush with the breast shape.

ASSESSMENT: TAKING THE CONSUMER’S HEALTH HISTORY

Assessment is the rst phase of the nursing process, and involves collecting subjective information about the consumer’s health status in order to identify the consumer’s problem areas to focus on.

Subjective data is most frequently collected during a health history and serves as

the starting point for the health professional to base the depth of their assessment on. The sections for the health history include:

> Consumer prole > Chief complaint (explained systematically using variations of location, quality,

quantity, associated manifestations, aggravating factors, alleviating factors, setting and timing. This is a variation on the OPQRST assessment mnemonic you may use for other conditions such as pain assessment)

> Past health history (including medical history, surgical history, allergies,

medications, injuries and accidents, special needs and childhood illnesses)

> Family health history > Social history (including alcohol, tobacco and drug use, sexual practice,

workand home environment, hobbies and leisure activities, stress and culture).

The health history example included here identies components for questioning the consumer about their health for this specic body system (breasts and regional nodes). Further, it guides the sequencing and highlights considerations for conducting the physical examination.

BREASTS AND REGIONAL NODES 397

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HEALTH HISTORY

CONSUMER PROFILE

CHIEF COMPLAINT

The breasts and regional nodes health history provides insight into the link between a consumer’s life and lifestyle and breast information and pathology.

Diseases that are age-, sex- and race-specic for the breasts and regional nodes are listed.

AGE

SEX

CULTURAL BACKGROUND

Common chief complaints for the breasts and regional nodes are dened and information on the characteristics of each sign or symptom is provided.

> Early menarche increases the risk of breast cancer (puberty) > Gynaecomastia (adolescent and elderly males) > Fibroadenoma (20–40) > Benign breast disease (cystic hyperplasia) (30–55) > Mastitis and plugged milk ducts (childbearing years) > Increasing risk of breast cancer (rst pregnancy after 30, or nulliparous) > Paget’s disease (postmenopausal) > Incidence of breast cancer increases (50 or older)

FEMALE > The incidence of breast cancer in Australia and New Zealand is

increasing. It was estimated in Australia in 2022 there would be 20 741 new cases of breast cancer diagnosed in women (up from 15 902 in 2013) (AIHW, 2021).

> See Table 12.2 for breast cancer risk factors.

MALE > The incidence of men being diagnosed with breast cancer has been

stable over the last three decades, with an estimation of 173 new cases in 2022 (142 in 2013) (AIHW, 2021).

> Gynaecomastia (adolescent and elderly men)

Aboriginal and Torres Strait Islander and Maˉ Caucasian women.

ori breast cancer mortality rate is higher than that of

CHAPTER 12

1. BREAST MASS Presence of a lump in the breast

LOCATION Anywhere in the breast or axilla, usually in the upper outer quadrant,

unilateral or bilateral

QUALITY Size, size in relationship to menstrual cycle, shape, consistency, mobility,

delineation of borders

QUANTITY Number of masses

2. BREAST TENDERNESS

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

TIMING Incidence rises with age, in relation to menses and ovulation

Sensation of discomfort in the breast

LOCATION Pinpoint, discrete, generalised; unilateral or bilateral

QUALITY Sharp, dull, pulling

ASSOCIATED MANIFESTATIONS

Tenderness, presence of dimpling, nipple retraction, nipple discharge, tender palpable lymph nodes

Methylxanthines (found in chocolate and coffee), recent injury to breast

Aspiration, biopsy, surgery, radiation, chemotherapy

Mass, dimpling, nipple retraction, breast swelling, premenstrual syndrome symptoms (see Chapter 17), induration, discharge, palpable nodes, fever,breastfeeding

398 PHYSICAL EXAMINATION

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HEALTH HISTORY

UNIT 2

PAST HEALTH HISTORY

AGGRAVATING FACTORS

ALLEVIATING FACTORS

TIMING In relation to menses or ovulation, pregnancy, lactation, activity

3. BREAST DISCHARGE

The various components of the past health history are linked to breasts and regional nodes pathology and related information.

MEDICAL HISTORY

Abnormal substance expressed from the breast

LOCATION From the nipple or sebaceous gland, unilateral or bilateral

QUALITY Colour, odour, consistency

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

TIMING In relation to pregnancy, menses, lactation, ovulation

BREAST-SPECIFIC Benign breast disease, cysts, broadenomas, intraductal papillomas,

Recent injury to breast, palpation, vigorous exercise, oral contraceptives, chlorpromazine, alpha-methyldopa

Warm compresses, analgesics, massage, support bras, aspiration, biopsy, surgery, breastfeeding, cessation of aggravating medications

Redness, swelling, induration, mass, dimpling, nipple retraction, breast swelling, palpable nodes, lactation, headaches, history of pituitary disorders, fever

Trauma to breast, breastfeeding, pituitary tumour, hyperthyroidism, chlorpromazine, alpha-methyldopa, digitalis, diuretics, oral contraceptives, papillomas, carcinomas of the ducts

Breastfeeding, biopsy, surgery, cessation of medications

mammary duct ectasia, mastitis, areas of greater density, breast cancer, masses, breast abscess, Paget’s disease, inammatory breast disease

FAMILY HEALTH HISTORY

NON-BREASTSPECIFIC

SURGICAL HISTORY

ALLERGIES Localised rashes of breast, contact dermatitis

MEDICATIONS Oral contraceptives, chlorpromazine, alpha-methyldopa, diuretics, digitalis, steroids and tricyclics

INJURIES AND ACCIDENTS

CHILDHOOD ILLNESSES

Breasts and regional nodes diseases that are familial are listed. Five to ten per cent of breast cancers are thought to have a familial link via a primary relative; for example, a mother, sister, grandmother. The link is stronger if the family history includes bilateral breast cancer, BRCA1 or BRCA2 gene mutation, Cowden or Hamartoma syndrome (PTENgenemutation), Li-Fraumeni (TP53 and CHEK2 gene mutations), Peutz-Jeghers syndrome (STK11 gene mutation), or ataxia telangiectasia (ATM).

Benign breast disease

Breast biopsy, lumpectomy, quadrantectomy, partial mastectomy, radical mastectomy, breast reduction or augmentation

may precipitate nipple discharge; use of hormone replacement therapy has been linked with increased incidences of some breast cancers

May cause haematoma or oedema; lumps may result from previous trauma to soft tissue

Varicella scarring of cutaneous tissue

Thyroid disorders, pituitary tumour, chest radiation, cancer of ovary or endometrium, obesity; lifetime weight gain associated with increased risk of postmenopausal breast cancer

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HEALTH HISTORY

SOCIAL HISTORY The components of the social history are linked to breasts and regional nodes factors and pathology.

ALCOHOL USE More than two drinks per day is associated with some risk; recurrent/current use increases risk

rather than past use; research shows a dose–response relationship

TOBACCO USE Cigarette smoking of long duration plays a role in breast cancer.

WORK ENVIRONMENT

HOME ENVIRONMENT

ECONOMIC STATUS Increased incidence of breast cancer in women of upper socioeconomic status.

CULTURAL BACKGROUND

TABLE 12.2 Breast cancer risk factors

NONMODIFIABLE FACTORS MODIFIABLE FACTORS RED FLAGS FOR HIGH-RISK FACTORS

> Female sex > Age greater than 50 > Personal history of breast cancer > Family history of breast cancer > Prior thoracic radiation (e.g. Hodgkin’s disease) > Number and result of prior breast biopsies (e.g. atypical hyperplasia) > Hereditary breast cancer syndromes:

• BRCA1 and BRCA2 are the majority of breast cancer syndromes

• Cowden or Hamartoma syndrome (PTEN gene mutation)

• Li-Fraumeni (TP53 and CHEK2 gene mutations)

• Peutz-Jeghers syndrome (STK11 gene mutation)

• Ataxia telangiectasia mutated (ATM)

> Reproductive history (earlier age at menarche, nulliparity, rst child

after age 30, late onset of menopause)

> African American/Ashkenazi Jewish heritage

Radiation exposure

Increased incidence of breast cancer noted in urban communities.

Incidence of breast cancer among Australian and New Zealand women is higher than that of Japanese and Middle Eastern women; it is estimated that 1 in 100 women of Ashkenazi Jewish origin are at greater risk of breast cancer due to a mutation of the BRCA1 gene.

> Increased alcohol consumption > Obesity > Physical inactivity > Cigarette smoking > Postmenopausal hormonal therapy

> Early age of onset of breast cancer

(<50 in consumer or family member)

> Multiple family members with

breast cancer

> Autosomal dominant pattern > Individual with more than one primary

breast cancer

> Male breast cancer at any age > Family member with known hereditary

mutation (e.g. BRCA1, BRCA2, TP53, PTEN)

> Family history of breast cancer and

ovarian cancer on same side of family

CHAPTER 12

PERSON-CENTRED HEALTH EDUCATION

When conducting a health assessment, opportunities for the provision of personcentred health education will arise. This is a signicant consideration in relation to the assessment process for examination of the breasts and regional nodes due to the intimate nature of the examination. These occasions are identied as individualised education and may generate further data that can be added to the assessment. All education given should be documented so that in future, health professionals can assess the impact of previous information provided to the consumer. (Refer to Chapter 1 for initiating health education.) Refer to the following examples.

INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS

Assessing the consumer for the following health-related activities can assist in identifying the need for education about these factors. This information provides a bridge between the health maintenance activities and breast and regional nodes function.

Diet No longer a correlation between a high-fat diet and incidence of breast cancer;

Exercise Strong correlation between obesity and incidence of breast cancer; in multiple

increased incidence of benign breast disease with caffeine use

studies there is a breast cancer reduction with increased activity

400 PHYSICAL EXAMINATION

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INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS

Use of safety devices Use of restraining devices in motor vehicles to prevent chest trauma

UNIT 2

Health check-ups

> Breast awareness starting in the 20s. > Healthcare providers should advise women to be ‘breast aware’ and inform

them about the changes that may indicate cancer, when women are having a general check-up.

> Women should discuss their individual needs and preferences with their

healthcare provider as there is no evidence that clinical breast examination as a screening method is of any benet.

> Clinical breast examination may be of benet for women who are eligible

but not attending regular mammography.

> Baseline mammography and annual mammography screening starting at

age 45 (NZ) and age 50 (Australia) in asymptomatic women.

> Women of all ages who are at high risk should have an individualised

surveillance program developed by their consultant. This may include regular clinical breast examinations, mammography, ultrasound/MRI. These women should also be encouraged to be breast aware (Breast Screen Australia, 2022; NZ National Screening Unit, 2022).

HEALTH EDUCATION

Reducing the risk of breast cancer

When undertaking a woman’s health history it is important to recognise the following, asthese have been linked to lowering the risk of breast cancer:

> Breastfeeding

> Moderate to vigorous physical activity

> Healthy body weight

> Stop smoking

> Low alcohol consumption.

Incorporate health education whenever appropriate, to inform women of these

modiable risks.

PLANNING FOR PHYSICAL EXAMINATION

The planning phase refers to evaluating subjective data to narrow the focus on physical examination, determining what objective data needs to be gathered, as well as considering the environment and equipment that will be required.

At this time, you will identify which of the four diagnostic techniques you will need to implement the physical examination, and how you will sequence these. For physical examination of the female breasts and regional nodes, you will include inspection and palpation.

Objective data is:

> collected during the physical examination of the consumer

> usually collected after subjective data

> information that is measured or observed by the clinician as opposed to being

reported by the consumer

> vital to the overall health assessment, to enable you to make clinical decisions

that are representative of the whole consumer picture.

Evaluating subjective data to focus physical examination

In the evaluation phase of a health assessment, the focus is on ensuring the data gathered is complete, accurate and documented appropriately (see case study

BREASTS AND REGIONAL NODES 401

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as an example of the focused assessment; see Chapter 22 for a comprehensive healthassessment). In evaluating the data you should:

> draw on your critical thinking and problem-solving skills to make sound

clinicaldecisions

> act on abnormal data (include communicating ndings to other health professionals)

> ensure documentation reects the outcomes of the clinical decisions/actions

taken (refer to Chapter 3, which discusses in detail why documentation is so important and how this may be undertaken in different health settings). The case study that follows steps you through this process.

Environment

Breast and regional node assessment and examination can be done in most physical environments in healthcare settings that will provide the level of privacy that is required. Reassuring the consumer that privacy will be maintained during the assessment by providing screens and/or closing the door will assist them to feel more at ease during the assessment.

Equipment

> Towel > Drape > Centimetre ruler > Teaching aid for breast awareness/self-examination.

CHAPTER 12

IMPLEMENTATION: CONDUCTING THE PHYSICAL EXAMINATION

Implementation of the physical examination and assessment requires you to consider your scope of practice. In this section, depending on your context, you may be performing foundation assessment with aspects of advanced assessment if you are practising in a specialised area. Physical examination can produce feelings of fear, anxiety, embarrassment and loss of control in many women. These feelings may be reduced by the sensitivity of the nurse before, during and after assessment of the breasts.

EXAMINATION IN BRIEF: BREASTS AND REGIONAL NODES

Examination of female breasts and regional nodes

Inspection

> Colour > Vascularity > Thickening or oedema > Size and symmetry > Contour > Lesions or masses > Discharge

Palpation

> Supraclavicular and infraclavicular lymph nodes > Breasts: consumer in sitting position > Axillary lymph node region > Breasts: consumer in supine position

Examination of male breasts

Inspection and palpation

General approach to examination of female breasts and regional nodes

Prior to the assessment

1. When possible, instruct the consumer not to use creams, lotions, powders,

or shave her underarms 24–48 hours before the scheduled examination. Application of toiletry products may mask or alter the nature of the surface

Advanced Assessment

402 PHYSICAL EXAMINATION

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UNIT 2

FIGURE 12.9 Position of consumer for

breast inspection: arms at side

integument of the breasts, and shaving the underarms may cause folliculitis, which may result in pain upon palpation.

2. Encourage the consumer to express any anxieties and concerns about

the physical examination. Acknowledge anxieties and validate concerns. Many women avoid having their breasts assessed because they fear social discomfort and potential adverse ndings. Assure the consumer that she has taken a positive step in her own health care by having her breasts assessed.

3. Inform the consumer that the examination should not be painful but may

be uncomfortable at times. This is especially true if the consumer is currently experiencing menses, ovulation or pregnancy.

4. Adopt a non-judgemental and supportive attitude.

5. Be aware of the impact of culture on breast assessment and breast

self-examination. In some Asian cultures, breast self-examination may be considered a form of masturbation. In some Middle Eastern cultures, baring the breasts to a male is taboo, even if the male is a healthcare provider.

6. Instruct the consumer to remove any jewellery that might interfere with

theassessment.

7. Ensure that the room is warm enough to prevent chilling, and provide

additional draping material as necessary.

8. Warm your hands with warm water or by rubbing them together prior to

theassessment.

9. Ensure that privacy will be maintained during the examination. Provide

screens, closed doors, and door sign stating that an examination is in progress.

FIGURE 12.10 Position of consumer for

breast inspection: arms overhead

FIGURE 12.11 Position of consumer for

breast inspection: hands pressed against hips

FIGURE 12.12 Position of consumer for

breast inspection: leaning forwards

During the assessment

1. Inform the consumer of what you are going to do before you do it.

2. Use this time to educate the consumer about her body.

3. Offer the consumer the opportunity to ask questions about her body

and sexuality.

4. Keep areas not being assessed appropriately draped.

5. Always compare right and left breasts.

6. Wear gloves if the consumer has any discharge from the breast.

After the assessment

1. Assess whether the consumer needs assistance in dressing.

2. After the consumer is dressed, discuss the experience with her, invite

questions and comments, listen carefully, and provide her with information regarding the examination.

Examination of female breasts and regional nodes

Inspection

1. Position the consumer uncovered to the waist, seated at the edge of the

examination table, and facing you.

2. Instruct the consumer to let her arms relax by her sides as shown in Figure 12.9.

3. Inspect the breasts, axillae, areola areas and nipples for colour, vascularity,

thickening, oedema, size, symmetry, contour, lesions or masses, and exudates.

4. Repeat the above inspection sequence with the consumer’s arms raised over

her head (see Figure 12.10). This will accentuate any retraction (tissue drawn back) if present.

5. Repeat inspection sequence with consumer pressing hands into hips, which

will contract the pectoral muscles (Figure 12.11). Once again, if retraction is present, it will be more pronounced with this manoeuvre.

6. Have the consumer lean forwards to allow the breasts to hang freely away

from the chest wall as shown in Figure 12.12, and repeat the inspection sequence. Provide support to the consumer as necessary.

ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology

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PUTTING IT IN CONTEXT

Breast examination: Cultural factors to consider

The nurse practitioner (NP) is conducting a well-woman examination on a 28-year-old consumer. The consumer made this appointment at the insistence of her husband, who wants to start a family. She has been in New Zealand for two years and has never had a female health assessment. She comes from a culture that highly respects women’s privacy and modesty. The female NP spends 10 minutes explaining the procedure and what to expect. As there are no questions, the NP gives the woman time to undress in privacy. The NP explains that the breast examination will be performed rst and inspects and then palpates the consumer’s breasts. The NP nds a small area she would like her ‘male’ colleague, working with her at the time, to also assess. The woman refuses, stating, ‘Only women may see me in a state of undress in my culture.’

> What might the NP say to the consumer? > What action would be taken?

Colour

Inspect the breasts, areolar areas, nipples and axillae for colouration.

The breasts and axillae are esh-coloured and the areolar areas and nipples are

darker in pigmentation. This pigmentation is normally enhanced during pregnancy. Moles and naevi are normal variants, and terminal hair may be present on the areolar areas.

Reddened areas of the breasts, nipples or axillae need further assessment.

Redness may be an indication of inammation, an infection such as mastitis,

orinammatory carcinoma (See types of breast cancer.)

Table 12.3 for a description of the ve major

CHAPTER 12

TABLE 12.3 Breast cancer types

DUCTAL CARCINOMA IN SITU (DCIS)

Cancer cells conned to the milk ducts. DCIS may present as microcalcications on mammography. There is no invasion to outlying tissue or lymph nodes.

INFILTRATING (INVASIVE) DUCTAL CARCINOMA (IDC)

Cancer cells have invaded tissues beyond the milk ducts. Constitutes 85–90% of all breast cancers. IDC will usually present as a discrete, solid breast mass on mammography.

INFILTRATING (INVASIVE) LOBULAR CARCINOMA (ILC)

Cancer cells that started in the lobules and milk ducts, have invaded outlying tissue. ILC represents 10% of breast cancers that may be more easily diagnosed from an MRI than mammography. This cancer may present as a thickened area rather than a mass.

INFLAMMATORY BREAST CANCER (IBC)

Cancer cells have rapid tumour growth with an erythemic, thickened skin or diffuse oedema (peau d’orange). IBC represents 1–6% of breast cancers. It is diagnosed via core biopsy or punch biopsy.

PAGET’S DISEASE Presents as an eczematous rash on the nipple. Represents 1–3% of

breast cancers. Pruritus, erythema and nipple discharge may be present. Paget’s disease can coexist with

Striae (Figure 12.13) are streaks over the breasts or axillae and are abnormal.

DCIS or IDC.

Inlight-skinned individuals, new striae are red and become silver to white incolouration with age. In dark-skinned individuals, new striae are a ruddy, darkbrown colour, and older striae become lighter than the skin colour.

Striae are caused by rapid stretching of the skin, which damages the elastic bres

found in the dermis. Though normal in pregnancy, striae are often also observed with obesity.

FIGURE 12.13 Striae secondary to

inammatory breast cancer; also note peau d’orange

UNIV ERSITY O F TEXA S, M.D. ANDE RSON

CANCER CENTER

COUR TESY OF DR S. E VA SINGLE TARY,

ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology

404 PHYSICAL EXAMINATION

deviation

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UNIT 2

COUR TESY OF DR S. E VA SINGLE TARY, UNIVE RSITY OF T EXAS , M.D. ANDER SON CANC ER CENTE R

FIGURE 12.14 Erythema with abnormal

vascular pattern secondary to inammatory breast cancer

CANCER CENTER

COUR TESY OF DR S. E VA SINGLE TARY,

UNIV ERSITY O F TEXA S, M.D. ANDE RSON

FIGURE 12.15 Peau d’orange

Vascularity

Observe the entire surface of each breast for supercial vascular patterns.

Normal supercial vascular patterns are diffuse and symmetrical.

Abnormal patterns of vascularity are focal or unilateral.

Focal or unilateral supercial vascular patterns (Figure 12.14) occur as the result of

an increased blood supply and may indicate tumour formation, which requires

increased vascularisation and an increased blood supply.

Thickening or oedema

Observe the breasts, axillae and nipples for thickening or oedema.

Normally, thickening or oedema is not found in the breasts, axillae or nipples.

Thickening or oedema of the breast tissue or nipple may present itself as enlarged

skin pores that give the appearance of orange rind (

more prevalent in the dependent or inferior portions of the breast (

This peau d’orange appearance may be indicative of obstructed lymphatic

peau d’orange). It may be

Figure 12.15).

drainage due to a tumour, or inammatory breast cancer.

Size and symmetry

Observe the breasts, axillae, areolar areas and nipples for size and symmetry.

It is not unusual for there to be some difference in the size of the breasts and

areolar areas, with the breast on the side of the dominant arm being larger.

Bilateral hypertrophy of the breasts may be normal for some consumers

(

Figure12.16). Nipple inversion, which is present from puberty, is a normal

variantand is of no clinical consequence except for difculty in breastfeeding.

Nipples should point upwards and laterally, or they may point outwards and

downwards (Figure 12.17A). Supernumerary nipples are a variant of normal and

have no pathological signicance in either males or females.

Asymmetry in the directions in which the nipples are pointed is an abnormal

nding (

Figure 12.17B).

COUR TESY OF ST EVEN M. LYN CH, M.D.

FIGURE 12.16 Massive hypertrophy

of breasts

COUR TESY OF DR S. E VA SINGLE TARY, UNIVE RSITY

OF TE XAS, M.D. A NDERSON C ANCER CE NTER

FIGURE 12.18 Asymmetry of breasts due

to cancer

A. Symmetrical without

FIGURE 12.17 Deviation of nipples

Asymmetrical nipple direction is suggestive of an underlying invasive process

B. Asymmetrical with

that is contorting nipple tissue. Often the direction of nipple deviation is

towards the underlying process.

Signicant differences in the size or symmetry of the breasts, axillae, areolar

areas or nipples are abnormal (see Figure 12.18).

Signicant enlargement of one breast, axilla or areola may be indicative of

tumour formation.

ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology

BREASTS AND REGIONAL NODES 405

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Recent inversion, attening or depression of a nipple is abnormal.

A sudden onset of nipple inversion, attening or depression is indicative of

nipple retraction, which is suggestive of an underlying cancer (Figure 12.19). Nipples that have been inverted since puberty and become broader or thicker

are abnormal. Additional broadening or thickening of a previously inverted nipple may be

indicative of tumour formation. Lack of breast tissue unilaterally is abnormal.

Unilateral reduction of breast tissue or structures may result from trauma,

FIGURE 12.19 Nipple retraction of

left breast

COUR TESY OF ST EVEN M. LYN CH, M.D.

mastectomy, or breast reduction.

Contour

1. Assess the breasts for contour.

2. Compare the breasts to each other.

The breast is normally convex, without attening, retractions or dimpling.

Dimpling, retractions, attening (

are abnormal. Changes in contour are highly suggestive of cancer. The invasive process that

causes the contour changes is the result of brotic shortening and disablement of the Cooper’s ligament. Fat necrosis and mammary duct ectasia may also cause retraction, dimpling and puckering.

Figure 12.20) or other changes in breast contour

CHAPTER 12

Lesions or masses

Inspect the breasts, axillae, areolar areas and nipples for lesions or masses.

The breasts, axillae, areolar areas and nipples are free of masses, tumours,

andprimary or secondary lesions. Breast masses, tumours, nodules or cysts of any kind are abnormal.

Table 12.4 for common pathologies of breast masses.

See

TABLE 12.4 Characteristics of common breast masses

GROSS CYST FIBROADENOMA CARCINOMA

Age 30–50; diminishes

after menopause

Shape Round Round, lobular or ovoid Irregular, stellate or

Consistency Soft to rm Usually rm Firm to hard

Discreteness Well dened Well dened Not clearly dened

Number Single or grouped Most often single Usually single

Mobility Mobile Very mobile May be mobile or xed to

Tenderness Tender Nontender Usually nontender

Puberty to menopause; peaks between ages 20 and 30

Most common after 50 years

crab-like

skin, underlying tissue or chest wall

COUR TESY OF DR S. E VA SINGLE TARY, UNIVE RSITY O F TEXA S, M.D. ANDE RSON CAN CER CENT ER

FIGURE 12.20 Dimpling of left breast tissue

Erythema No erythema No erythema May be present

Retraction/dimpling Not present Not present Often present

A scaly, eczema-like erosion of the nipple, or persistent dermatitis of the areola

and nipple, is abnormal.

ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology

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