Breast lumps : a simple guide to diagnosis and management
This is written with the aim of helping my medical students and doctors in training go through my thought process in the outpatient clinic. This list is not meant to be all comprehensive but rather a practical guide in coming to a diagnosis quickly.
Take a full history:
including age, past history and family history
age of menarche, menopause and pregnancies(breast feeding history)
Ask too for nipple discharge ?blood stained(papilloma and cancer), greenish(duct ectasia, fibrocystic disease)
On examination:
Feel for suspicious features of a breast cancer – be especially suspicious of any hard lump in woman over 50yo
In young woman, if the lump is mobile – most likely fibroadenoma
Investigation:
Ultrasound ?fibroadenoma ?cyst ?breast cancer
Mammogram
Tissue diagnosis to complete triple assessment – Fine needle aspiration cytology , biopsy
Other causes –
Skin/subcutaneous lump – epidermal cyst
Silicone granuloma – there are some patients who may have had injections of silicone overseas many years ago(now the women are usually more than 50 years old and their breast cancer risks are increasing)