Breast HA Exam #4

Pain (cyclic) = menstruation
Lump = when, where
Discharge = usually symptom of cancer, unilateral or bilateral, odor, normal up to 1 year after breast feeding
Rash
Swelling = bilateral comparison
Trauma
History of breast disease
Surgery = reduction or breast augmentation
Self-care behaviors = mammograms, self exams
Perform self-examination
Last mammogram

sudden, spontaneous, and unilateral

breast tissue extends up to anterior axilla
Tenderness, lump, or swelling
Rash

female sex, age >50
personal history of breast cancer
mutation of BRCA1 or BRCA2 genes
first-degree relative with breast cancer (mother, sister)
previous breast biopsy with atypical hyperplasia, or breast disease without atypia or usual hyperplasia
previous breast irradiation
menstruation before age 12 years or menopause after age 50 years

nulliparity or first child after age 30
recent oral contraceptive use
postmenopausal hormone therapy (combined estrogen and progesterone therapy)
not breastfeeding
alcohol intake of >1 drink daily
obesity (esp after menopause) and high-fat diet
physical inactivity

choice to start annual mammogram screening
weight riskenefits

mammogram every year

mammogram every 2 years with choice to continue on annual basis
continue while woman is in good health and life expectancy is at least 10 years
older you get more likely to get

all women should be familiar with breast tissue and know who to contact if change occurs

position--supine
draping--expose one at a time

measuring tape
pamphlet (BSE)

note symmetry of size and shape
one shouldn't be perky and other dimpled and orange looking

normally smooth and of even color
note any localized areas of redness, bulging, or dimpling
normally no edema is present

should be symmetric
normal nipple inversion may be unilateral or bilateral
note any dry scaling, any fissure or ulceration, and bleeding or other discharge

Yes

axillary tail of spence

Upper inner
Upper outer
Lower inner
Lower outer
Axillary tail of spence
measure size wise from nipple

normal variation
follows the path of Embryonic 'milk line'
occurs during development
often called an 'extra nipple'

dimpling or puckering
fibrosis of tissue

growing neoplasms

lift arms over head
push hands into hips
lean forward with forearm support

use the pads of your first three fingers and slide them, not lift
use gentle rotary motion on the breast
choose one of three patterns
**don't forget the nipple**

Vertical Strip Pattern
Spokes-on-a-Wheel
Concentric Circles
feel something on one side, make sure to check the other side

more common in older patients
bimanual method
sitting, leaning forward

firm transverse ridge of compressed tissue in the lower quadrants
noticeable in large breasts
**Normal Finding**

retroareolar = behind the nipple

Location--distance in cm from the nipple (eg. 7:00, 2cm from the nipple)
Size--cm in three dimensions: width x length x thickness
Shape--oval, round, lobulated (chewed up bubble gum) or indistinct
Consistency--soft, firm, or hard?
Moveable--freely moveable or fixed
Distinctness--solitary or multiple?
Nipple--displaced or retracted? Discharge?
Note skin over lump--erythematous, dimpled, or retracted?
Tenderness--tender to palpation?
Lymphadenopathy--lymph nodes palpable?

caffeine

Schedule of self-exam
regular schedule
right after menstrual period
select familiar date (post menopause)
Describe correct technique
Return demonstration

solitary, unilateral star-shaped mass
often non-tender
firm to stony hard, fixed mass
borders irregular, poorly delineated
grows constantly
skin retraction
most common site: Tail of Spence