1
Q
How do you properly position/drape a patient when conducting a breast examination?
A
- Adequate inspection initially requires full exposure of the chest, but later in the examination, cover one breast while you are palpating the other.
- Inspect the breasts and nipples with the patient in the sitting position and disrobed to the waist
- The inspection should occur in four views—arms at sides, arms overhead, arms pressed against hips, and leaning forward.
- When examining an adolescent girl, assess her breast development according to the Tanner sex maturity ratings
2
Q
What 4 characteristics do you assess for when inspecting the breast?
A
- Color - Breasts should have a normal even distribution of color.
- Redness suggests local infection or inflammatory carcinoma
- Size - Some differences in the size of the breasts and areolae are common and usually normal
- Contour - Look for changes such as masses, dimpling, or flattening. Compare one side with the other.
- `Flattening of the normally convex breast suggests cancer
- Nipples - The characteristics of the nipples, including size and shape, the direction in which they point, any rashes or ulceration, or any discharge.
- Asymmetry due to change in nipple direction suggests underlying cancer.
3
Q
How do you assess for breast dimpling or retractions and what do these findings suggest?
A
- To bring out dimpling or retraction that may otherwise be invisible, ask the patient to raise her arms over her head, then press her hands against her hips to contract the pectoral muscles.
- Breast dimpling or retraction in these positions suggests underlying cancer. Cancers with fibrous strands attached to the skin and fascia over the pectoral muscles may cause inward dimpling of the skin during muscle contraction.
4
Q
What techniques should be used when palpating the breast?
A
- Palpation is best performed when the breast tissue is flattened. The patient should be supine.
- Use the pads of the 2nd, 3rd, and 4th fingers, keeping the fingers slightly flexed. Use a vertical strip pattern shown in is the best-validated technique for detecting breast masses.
- Palpate in small, concentric circles applying light, medium, and deep pressureat each examining point. Press more firmly to reach the deeper tissues of a large breast.Examine the entire breast, including the periphery, tail, and axilla.
5
Q
How do you examine the lateral portion of the breast?
A
- To examine the lateral portion of the breast, ask the patient to roll onto the opposite hip, placing her hand on her forehead but keeping the shoulders pressed against the bed or examining table.
- This flattens the lateral breast tissue.
- Begin palpation in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle.
- Continue in vertical overlapping strips until you reach the nipple, then reposition the patient to flatten the medial portion of the breast.
6
Q
How do you examine the medial portion of the breast?
A
- To examine the medial portion of the breast, ask the patient to lie with her shoulders flat against the bed or examining table, placing her hand at her neck and lifting up her elbow until it is even with her shoulder (Fig. 10-13).
- Palpate in a straight line down from the nipple to the bra line, then back to the clavicle, continuing in vertical overlapping strips to the midsternum.
7
Q
What 5 characteristics should you note when palpating the breast?
A
- Consistency - Normal consistency varies widely, depending on the proportions of firmer glandular tissue and soft fat.
- Physiologic nodularity may be present, increasing before menses.
- Note the firm inframammary ridge, which is the transverse ridge of compressed tissue along the lower margin of the breast, especially in large breasts.
- Tenderness - may occur prior to menses
- Nodules - Palpate carefully for any lump or mass that is qualitatively different from or larger than the rest of the breast tissue.
- Elasticity - Thickening of the nipple and loss of elasticity suggest an underlying cancer
- Discharge - Note the color, consistency, and quantity of any discharge and the exact location where it appears.
8
Q
What are the 7 characteristics to assess and describe in a nodule/mass of the breast?
A
- Location—by quadrant or clock, with centimeters from the nipple
- Size—in centimeters
- Shape—round or cystic, disclike, or irregular in contour
- Consistency—soft, firm, or hard
- Delimitation—well circumscribed or not
- Tenderness
- Mobility—in relation to the skin, pectoral fascia, and chest wall. Gently move the breast near the mass and watch for dimpling.
9
Q
How do you properly position a patient for examination of the axillae and what 3 characteristics do you inspect for?
A
- Although the axillae may be examined with the patient lying down, a sitting position is preferable.
- Inspect the skin of each axilla, noting evidence of:
- Rash
- Infection
- Unusual pigmentation - Deeply pigmented velvety axillary skin suggests acanthosis nigricans— associated with diabetes; obesity; polycystic ovary syndrome; and, rarely, malignant paraneoplastic disorders.
10
Q
When is the best time in the menstrual cycle to do a breast self-exam?
A
The BSE is best timed 5 to 7 days after menses, when hormonal stimulation of breast tissue is low
11
Q
What is a fibroadenoma and at what age does this usually occur?
A
- A fibroadenoma is a benign, non-cancerousus breast tumor. Unlike a breast cancer, which grows larger over time and can spread to other organs, a fibroadenoma remains in the breast tissue.
- Usually seen in patients 15–25 years old, usually puberty and young adulthood, but up to age 55 years
12
Q
(Number, Shape, Consistency, Delimitation, mobility, tenderness, retraction signs)
What are some characteristics of fibroadenomas?
A
- Number: Usually single, may be multiple
- Shape: Round, disclike, or lobular; typically small (1–2 cm)
- Consistency: May be soft, usually firm
- Delimitation: Well delineated
- Mobility: Very mobile
- Tenderness: Usually nontender
- Retraction signs: Absent
13
Q
What are fibrocystic breasts and in what age group does this usually seen?
A
- Fibrocystic breast condition occurs when there is lumpiness in one or both breasts.
- Occurs in patients 30-50 years old, regress after menopause except with estrogen therapy
14
Q
(Number, Shape, Consistency, Delimitation, mobility, tenderness, retraction signs)
What are some characteristics of fibrocystic breasts?
A
- Number: Single or multiple
- Shape: Round
- Consistency: Soft to firm, usually elastic
- Delimitation: Well delineated
- Mobility: Mobile
- Tenderness: Often tender
- Retraction signs: Absent
15
Q
What are the risk factors for breast cancer?
A
- The most important risk factor for breast cancer is age
- Family history of breast and ovarian cancers
- Inherited genetic mutations
- Personal history of breast cancer or lobular carcinoma in situ
- High levels of endogenous hormones,
- Breast tissue density
- proliferative lesions with atypia on breast biopsy, and duration of unopposed estrogen exposure related to early menarche
- Age of first full-term pregnancy
- Late menopause
16
Q
(Number, Shape, Consistency, Delimitation, mobility, tenderness, retraction signs)
What are some characteristics of breast cancer?
A
- Number: Usually single, although may coexist with other nodules
- Shape: Irregular or stellate
- Consistency: Firm or hard
- Delimitation: Not clearly delineated from surrounding tissues
- Mobility: May be fixed to skin or underlying tissues
- Tenderness: Usually nontender
- Retraction signs: May be present
17
Q
What is and what causes paget’s disease of the breast?
A
- It is a rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around it, which is called the areola.
- The most widely accepted theory is that cancer cells from a tumor inside the breast travel through the milk ducts to the nipple and areola
18
Q
What are the symptoms of Paget disease of the breast?
A
- The symptoms of Paget disease of the breast are often mistaken for those of some benign skin conditions, such as dermatitis or eczema. These symptoms may include the following:
- Itching, tingling, or redness in the nipple and/or areola
- Flaking, crusty, or thickened skin on or around the nipple
- A flattened nipple
- Discharge from the nipple that may be yellowish or bloody
- Suspect Paget disease in any persisting dermatitis of the nipple and areola
19
Q
When should women begin getting mammography?
A
According to the American cancer society women aged:
- 40–45 years — optional annual screening
- 45–54 years — annual screening
- ≥55 years — biennial screening with option to continue annual screens. Continue screening if good health and life expectancy ≥10 years
HA Ex4
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